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20180129

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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Gastrointestinal

Unclogging Enteral Feeding Tubes (Adult and Pediatric) (2.22AP)

Unclogging Enteral Feeding Tubes (Adult and Pediatric) (2.22AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Gastrointestinal

2.22AP

NURSING PATIENT CARE POLICY & PROCEDURE

I. PURPOSE

A. To restore patency of enteral feeding tubes (including nasogastric, small-bore
nasoenteric, gastrostomy and jejunostomy feeding tubes) in adults and pediatric patients
due to an actual blockage. This policy does not apply to mechanical occlusions.
Occlusions may occur due to a mechanical distortion of the enteral tube or an actual
blockage of the lumen related to the accumulation of administered products.
B. Pancreatic enzymes are used to restore patency in enteral tubes when the blockage is
thought to be related to the accumulation of products administered via the enteral tube: it
is not to be used to restore patency if there is concern for a malpositioned enteral tube.

II. POLICY

• The use of pancreatic enzymes to unclog enteral feeding tubes in adults and pediatric
patients is performed only with a provider's order.
• Cranberry juice and carbonated beverages are not recommended to flush feeding tubes as
these agents have a high propensity to clog feeding tubes. The acidic properties of these
solutions can cause precipitation of tube feeding formulas.
• Meat tenderizer should not be used to unclog tubes.
• Use sterile water for immunocompromised patients and pediatric patients.

III. EQUIPMENT

A. Tap water for irrigation
B. Sterile water for immunocompromised patients and pediatric patients.
C. Pancrelipase-sodium bicarbonate unclogging kit from pharmacy, which includes a 60 mL
ENFIT syringe, sodium bicarbonate and pancrelipase (Creon) capsules.
D. 60 mL luer tip syringe for pediatrics (CS# 2200688)
E. Pill crusher

IV. PROCEDURE

A. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand Hygiene.
Wear gloves as appropriate.
B. With a 60 mL ENFIT syringe (adults) or 60 mL luer lock syringe (pediatrics), withdraw
any enteral solution remaining within the feeding tube.
C. Administer warm water into the feeding tube.
1. Adults: 60 ml via ENFIT syringe





Effective Date:
January 26, 2018

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 2.22 AP

Original
Revision

Page
1
of 3

Title: Unclogging Enteral Feeding Tubes
(Adult & Pediatric)

Page 2 of 3

2. Pediatrics:




3. Instill water into tube
4. If resistance is met, move plunger in gentle back-and-forth motion to loosen clog
5. Clamp, cap or turn stopcock to off for 30 minutes.
6. Unclamp/uncap tube or open stopcock and pull back on plunger with controlled
pressure.
7. If unclogged, flush to ensure patency is restored. For adult patients flush with at
least 30 mL of water. For pediatric patients, refer to table.
D. If tube remains clogged, obtain an order from provider for unclogging the tube. This
order must include the medications in the kit from pharmacy. To order the provider
should, type “unclog” in the search field for the order set.
E. Administer alkalinized pancrelipase/sodium bicarbonate enzyme solution.
1. Follow the directions listed below to prepare pancrelipase/sodium bicarbonate
enzyme solution.
a. Check to ensure the patient does not have any contraindications to
receiving pork products.
b. Crush sodium bicarbonate tablet into a fine powder.
c. Empty contents of pancrelipase capsules into amber vial and combine with
sodium bicarbonate powder.
d. Document patient name and medical record number on affixed label.
e. Add 10-20 mL sterile water to the powder mixture. Mix thoroughly until
all microcapsules are dissolved. This may take up to 15 minutes.
f. Transfer mixture to 60 mL ENFIT syringe (60 mL luer lock syringe for
pediatrics). No syringe smaller than 30 mL should be used as this may
cause damage to the feeding tube.
2. Aspirate from the tube with an empty 60 mL syringe (adults) or 60 mL luer lock
syringe (pediatrics), drawing back air and immediately clamping or turning the
stopcock to the off position while continuing to hold the syringe plunger.
3. Remove the air filled syringe and replace it with the syringe containing the
enzyme solution.
4. Open the clamp or turn the stopcock to the open position. Some of the solution
will automatically be drawn into the tubing by negative pressure.
5. Gently attempt to manually administer the remaining solution. For infants, instill
5-10 mL to prime the tube or until you meet resistance.
6. Clamp the tubing or turn the stopcock off for up to 30 minutes. Discard any
remaining solution left in the syringe.
7. After 30 minutes, attach 60 mL ENFIT syringe (adults) or 60 mL luer lock
syringe (pediatrics) and gently agitate the contents of the feeding tube with a
gentle pushing and pulling of syringe plunger.
8. If tube becomes unclogged, push and administer the enzymatic solution through
the tube.
a. Flushing feeding tubes is the best way to prevent tube occlusion. Flushing
should be performed routinely with 30mL of water (see table above for
pediatric patients) every 4 hours and preceding and following the
administration of medications.
Age Volume
Birth to 10 years Minimum of 3 mL or 1 mL/year of age
Over 10 years 10-30 mL

Page 3 of 3

b. To prevent tube rupture, it is recommended that ENFIT syringes smaller
than 30 mL should not be used for flushing.
9. If the feeding tube remains clogged, the above process can be repeated 1 time by
preparing another alkalinized pancrelipase/sodium bicarbonate enzyme solution.
Obtain new provider order and repeat.
10. After clearing the tube, flush the tube with an additional 30 mL of water (see table
above for pediatric patients).
11. Document procedure and results in the patient’s clinical record.
12. If unable to clear, contact provider to discuss removal of the tube, replacement or
maintenance of the G-tube tract opening.

V. REFERENCES

A. Boullata, J.,Carrera, A., Harvey, L.,and ASPEN Safe Practices for Enteral Nutrition
Therapy Task Force, American Society for Parenteral and Enteral
Nutrition.(2017),ASPEN Safe Practices for Enteral Nutrition Therapy. Journal of
Parenteral and Enteral Nutrition, 41(1), 15-103.
B. Mitchell, J. F. (2009). Institute of Safe Medication Practices. Oral dosage forms that
should not be crushed. Available at: http://www.ismp.org/tool/donotcrush.pdf.
Accessed March 2, 2010.
C. Mueller, C.M. (ed.) (2012), The A.S.P.E.N. Adult Nutrition Support Core
Curriculum, 2nd Edition. American Society for Parenteral and Enteral Nutrition,
Silver Spring, MD.
D. Pancrelipase (Creon®) (2010). Marietta, GA: Solvay Pharmaceuticals, Inc.
E. Rucart, PA, Boyer-Grand, A., Sautou-Miranda, V., Bouteloup, C., Chopineau, J.
(2011). Influence of unclogging agents on the surface state of enteral feeding tubes.
Journal of Parenteral & Enteral Nutrition, 35(2), 255-263.
F. Williams, N. T. (2008). Medication administration through enteral feeding tubes. Am
J Health-Syst Pharm, 65, 2347-2357.

VI. REVIEWED BY

AFCH Practice Committee
Nutritionist, Registered Dietitian
Clinical Nurse Specialist, Acute Medical & Progressive Care
Clinical Nurse Specialist, Universal Care Unit & Float Team
Clinical Nurse Specialist, Wound & Skin
Nursing Patient Care Policy and Procedure Committee, January 2018

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive