Apparatus and methods for clearing obstructions from a medical tube are disclosed. In an exemplary embodiment, a spool drive system is disclosed for actuating a guide wire within a medical tube. The spool drive system can be a hand held, disposable device having a spool housing with a spool therein for alternately advancing and withdrawing a guide wire through an inlet of the spool housing. A track can be spaced from and extend about a perimeter of the spool to direct the guide wire onto or off of the spool as the spool is rotated. Other embodiments and devices for actuating the guide wire, and methods therefor, also are disclosed.