When a patient's enteral feeding tube becomes clogged, both the feeding and your schedule come to an abrupt halt. Clogged tubes can be time-consuming to unclog and expensive to replace. They interrupt the patient's supply of nutrients and cause him discomfort, and they're discouraging to everyone involved.
Many nursing policies recommend flushing feeding tubes with 20-30 ml of water every four to six hours, and before and after administering medications or checking gastric residuals. (1) Even with these policies, the rate of feeding tube occlusion is approximately 12.5%. (2)
Tube occlusion was a major concern at our hospital, a 649-bed regional community teaching medical center and Level 1 trauma facility. In addition to caring for our admitted patients with tubes, the Nutritional Support Services (NSS) nurses see outpatients from home, clinics, and senior-care and extended-care facilities.
To minimize the impact of tube occlusion at our hospital, the NSS nurses began to research ways to unclog feeding tubes. This article describes the two methods we found that work the best and the process we went through to find and evaluate them.
A common problem at our facility
Most of our patients who require enteral nutrition are initially fed through small-bore feeding tubes (SBFT) inserted nasally or orally and advanced to the ligament of Treitz at the junction of the duodenum and the jejunum. Others are fed through gastrostomy or jejunostomy tubes placed by physicians in the OR, radiology department, or GI laboratory. Occasionally, patients are fed through large-bore (16 F) nasogastric or orogastric tubes.
Small-bore tubes are more prone to clogging than large-bore tubes, and we soon realized that clogging of these tubes was a major cause of feeding downtime. A patient with an occluded tube could miss several hours of feeding before the tube was unclogged or replaced--a situation that could lead to nutritional deficiencies if it were to recur. A clogged tube could also delay the administration of medication. This concerned us, as did our patients' discomfort and the expense incurred by having to replace tubes that could not be unclogged.
Our policy was to first try to clear the clogged tube by instilling water, but this didn't always work. To save patients the discomfort and time of having a new tube inserted, we wanted to determine if any other methods of clearing the tube might be more effective.
We began our research by reviewing the literature and found an abundance of information about SBFT placement techniques, routine care, and complications. We located a number of articles on maintaining tube patency, but very little information on restoring it.
After reviewing the literature, we identified several common causes of tube occlusion. Tubes were likely to clog when formula bags were allowed to run dry, the tube was not adequately or routinely flushed, or medications were administered improperly through the tube. (3,4) Improper medication administration includes not fully crushing a drug, giving two or more drugs simultaneously, giving a drug and formula together, and giving a drug without flushing before and...
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