Feeding-Tube Blockage, Leakage, or Replacement

This page is for people with a feeding tube at home and the people who help care for them. It covers the main tube types, what to do if a tube comes out, and how to prevent and handle blockage, leaks and skin problems.

A feeding tube carries liquid food, water and medicine straight into the stomach or the small bowel, through a small opening in the abdominal wall called a stoma. It is used when swallowing is unsafe, too painful, or physically blocked.

In cancer care, the usual reasons are dysphagia, meaning difficulty swallowing, from cancer of the esophagus or the throat, and the raw, swollen mouth and throat that can follow radiation therapy to the head and neck. Some tubes go in before treatment starts, so that weight and strength hold up during it.

The common types:

• PEG, short for percutaneous endoscopic gastrostomy. A camera passed through the mouth guides the tube into the stomach. It is held inside by a soft disc, the internal bumper.
• Radiologically inserted gastrostomy, placed under X-ray. It is used when a camera cannot pass, which is common in head and neck cancer.
• Balloon replacement tube or low-profile button. A small water-filled balloon holds it in. Buttons sit almost flat against the skin.
• G-J or PEG-J tube, with an extension that carries feed past the stomach into the jejunum, part of the small bowel. It is used for people who reflux or breathe feed into the lungs.

The tube does not sit in an open hole. After placement, a channel called a tract slowly forms between the stomach and the skin. For a first tube, that usually takes about 2 to 4 weeks, and it can take longer in some people. Ask your team when yours is expected to be mature.

If a tube comes out before the tract has matured, the risk of serious complications is higher, including peritonitis, a dangerous infection inside the belly. Putting a tube back into a young tract is a job for the medical team, not something to try at home.

After the tract has matured, the same event is less dangerous but still urgent. MedlinePlus says that once the tube is out, the opening may begin to close, and a new tube should be placed right away. How fast it closes varies from person to person, and it can start within hours.

Call 911 or go straight to the emergency room if:

• The tube has come out and it was placed less than 4 weeks ago. Do not try to put anything back. Cover the opening with clean dry gauze and go now.
• Severe belly pain begins, or the belly becomes hard, rigid, or swollen and tender. This includes pain, fever or vomiting that starts after a tube change or after restarting feeds.
• Heavy bleeding comes from the tube or the stoma.
• Someone coughs, chokes, gurgles, or becomes breathless during a feed, or feed appears in the mouth. Stop the feed immediately and sit them upright.

Call your care team right away, day or night, if:

• Temperature is 100.4 °F (38 °C) or higher and the person is having chemotherapy or another cancer treatment. The CDC says to call your doctor immediately at that temperature. If you cannot reach anyone, go to the emergency room and say the person is on cancer treatment.

Call the tube team or nutrition nurse the same day if:

• The tube has come out and it is more than 4 weeks old. This is still a race. Cover the hole, do not force anything in, and be seen within hours, not tomorrow.
• The tube will not flush at all, or feeds will not run.
• Fluid leaks around the tube and soaks dressings or clothing.
• The skin around the stoma is red, sore, hot, or oozing yellow or green fluid.
• The tube has slid outward or inward, so the number or mark at the skin has changed.
• Feeds now cause vomiting, or the belly is hard and swollen an hour after every feed.

If the tube is out and you have been trained and told to do so, a clinician may ask you to slide a spare tube or catheter gently into the tract to hold it open. Only do this if your team has taught you, and never force it. Otherwise, putting a tube back is a job for the medical team.

Blockage is a common problem, and much of it can be prevented. Feed and crushed medicine dry into a plug inside the tube.

Prevention comes first. Flush with water before and after every feed and after every single medicine. Never put whole tablets down a tube. Ask the pharmacist for a liquid form, or for the tablets that can safely be crushed. Give medicines one at a time, with a flush between each.

To clear a tube that has blocked, use warm water and a large syringe. Draw back gently and push gently, over and over, letting the water sit for a few minutes between attempts. Patience clears most of them.

Do not push a wire, a straightened coat hanger, a skewer, or a guide wire into the tube. Do not pour in fizzy drinks or fruit juice unless your team specifically told you to. Some services stock an enzyme declogging kit; ask whether yours does.

Some seepage is normal at first. Persistent leaking is not, and it usually means one of four things: the balloon has lost water, the tube is too loose or too tight, the stoma has stretched, or the stomach is not emptying.

If you have a balloon tube, the balloon can quietly lose water over weeks. How much fluid it should hold, and which fluid, is set by that particular device and is printed on the tube and in its manual; there is no figure that fits every tube, so read yours or ask the tube team rather than working from a general number. Check that the tube is still at the same number at the skin. Report leaks rather than padding them with more gauze, because leaking stomach juice burns skin fast.

Do not change to a different tube size yourself to stop a leak. Let the team decide.

A rare problem called buried bumper happens when the internal disc moves into the stomach wall. Tell the tube team the same day if the tube will not rotate or move the way you were taught, feeds will not run, feeding hurts, or it leaks.

Keep the site healthy. Clean the skin around the tube 1 to 3 times a day with mild soap and water or saline, then dry it well. MedlinePlus advises rotating the tube a bit so it does not stick to the opening. Do this only in the way your team showed you, and settle it back at the same mark.

Sit upright for every feed and stay upright afterwards. Do not feed anyone lying flat. Do not use feed that has hung for more than 4 hours. If diarrhea starts, call the tube or nutrition team for advice before altering anything. They may have you slow the rate or pause briefly rather than stop food altogether, but that call is theirs to make.

• National Library of Medicine (PMC) — Wound care management: tracheostomy and gastrostomy
• MedlinePlus — PEG tube insertion: discharge
• MedlinePlus — Enteral nutrition (child): managing problems
• MedlinePlus — Gastrostomy feeding tube: bolus
• CDC — Watch Out for Fever (Preventing Infections in Cancer Patients)