Educating your Patients about Tube Maintenance

Clogged feeding tubes can be responsible for loss of nutrition as well as increased risks and costs for tube replacement. Teaching patients how to prevent clogs and perform feeding tube maintenance can help them to avoid this problem.

Estimates[1] put clogged feeding tubes between 12.5% to 45% over the life of a tube. In a recent survey, 68% of Australian and New Zealand Dietitians reported tube clogging as a main complication experienced by their enterally fed patients[5]. Clogged feeding tubes can lead to costly replacements especially if the patient needs to go to hospital for the procedure. Additionally, you may have experienced patients who have tried anecdotal declogging remedies such as cranberry juice, cola, meat tenderizer or pipe cleaners. Not only are these methods ineffective but they are potentially unsafe. Help your patients use appropriate prevention and declogging methods using the below information.

ā€œEstimates put clogged feeding tubes between 12.5% to 45% over the life of a tubeā€1

What are some effective methods for declogging a feeding tube?

  • Warm Water Flush[1]. Literature supports immediate warm water flushing accompanied by gentle back and forth motion with a syringe as the best method for unclogging a tube. Teach patients that too much force is not their friend as the tube could rupture. The size of the syringe matters, too. Patients should use a 30 milliliter or larger syringe for gastrostomy tubes, and a 60 milliliter syringe for nasoenteric or jejunostomy tubes. For stubborn clogs, have patients clamp the tube and let it soak in lukewarm water for up to 20 minutes.
  • Enzymatic Clog Dissolver[1]. If water is unsuccessful, have patients try an enzyme solution. The only recommended products are Viokace[2], which requires a prescription, and Clog Zapper, an available commercial product. Enzymatic dissolvers which are enteric coated cannot be used for declogging.[1]
  • Mechanical Tools[1]. Mechanical tools are not for home use and therefore should not be advised for DIY declogging. Inform patients that they should call you if warm water flushing[3] or an enzymatic clog dissolver cannot resolve the clog. A mechanical declogging procedure may be available to them through their medical facility and could save them the expense and risks of tube replacement.

How can you help prevent feeding tube clogs?

While patients canā€™t always prevent clogs, a few methods of prevention may be worthwhile to pass on including:[3]

  • Select the largest diameter tube feasible for comfort
  • Check all medications[4] with the pharmacy to ensure correct timing, proper spacing, avoiding capsules or timed medications from being added directly to the tube, and that all tablets are crushed to fine powder
  • Medications can be flushed with at least 15 milliliters of water before, after and between each medication and when done administering medications
  • Flush tubes routinely with tepid water and with at least 30 milliliters of water for nocturnal or continuous feedings
  • For bolus feedings, flush at least 60 milliliters of tepid water before and after infusions
  • Review all flushing instructions per the manufacturers IFU and become familiar with them
  • Keep clear, written instructions at home, including when to seek help with clogs

 

With just a little education and consistent flushing with water, your patients can do their best to maintain and prevent feeding tube clogs properly at home, avoid dangerous DIY remedies and the associated costs of tube replacement. By sharing these best practices with your patients, you may help cut down on feeding tube clogging and unnecessary patient risks and expense.

References

  1. https://practicalgastro.com/2014/03/13/clogged-feeding-tubes-a-clinicians-thorn/
  2. https://www.rxlist.com/viokace-drug.htm
  3. https://www.ebscohost.com/assets-sample-content/Feeding_Tube_Irrigation_Performing_-_NSP.pdf
  4. https://www.medscape.com/viewarticle/585397_10
  5. Dietitian Connection. Avanos Medical Survey Report September 2020. p11
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