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GOOD SAMARITAN HOSPITAL
Vincennes, Indiana

Approved: 6/2020 Index: C 03.06.20.16

Pages: 3

CLOGGED FEEDING Hospital Wide

TUBE POLICY
President/CEO Approval

Prepared by:
Approved by:
P&T Com 5/20 Clinical Dietitian
HospWide P&P Com 6/20

PRINTED COPIES OF THIS DOCUMENT ARE NOT CONTROLLED AND ARE CONSIDERED FOR REVIEW, REFERENCE, AND/OR
TRAINING PURPOSES ONLY. FOR LATEST COPY, REFER TO THE ELECTRONIC COPY ON THE GOOD SAMARITAN INTRANET.

POLICY: The RN will perform appropriate steps to attempt to resolve clogged enteral tubes. In the event an enteral
feeding tube becomes clogged water should be used first due to proven efficacy and no risk of adverse effects. If water is
ineffective at removing the occlusion a physician’s order is to be obtained for the use of pancreatic enzyme/sodium
bicarbonate solution to treat a clogged enteral feeding tube. The order must specify drug name, dosage, route and
indication.

PURPOSE: To re-establish a patent/functioning feed tube.

BACKGROUND:
A common cause for an enteral feeding to fail is tube occlusion, with an incidence rate as frequent as 23%–
35%.1 Feeding tubes are prone to clogging for a variety of reasons including: feeding tube properties (narrow tube
diameter and the tube material), the tube tip location (gastric vs small bowel), insufficient water flushes, formula
contact with acidic fluid, aspiration for gastric residual volume (GRV), contaminated formula, and incorrect
medication preparation and administration.1, 2 Tube obstructions delay the administration of nutrition support and
medications. Prompt restoration of tube patency may improve nutrition support and has the potential to save
healthcare resources devoted to tube replacement.
Currently the American Society for Enteral and Parenteral Nutrition (ASPEN) recommends water for the
first intervention to be used when a tube becomes occluded. If this fails to remove the clog the next treatment
recommended is using a mixture of non-enteric coated pancreatic enzyme solution and sodium bicarbonate.3, 4
Research has shown enteric‐coated and extended‐release pancreatic enzymes to not be effective for dissolving
obstructions in enteral feeding tubes.4,5 The use of cranberry juice and/or carbonated beverages is not recommended
as it may worsen clogs. The acidic pH of these fluids can cause proteins in enteral formula to precipitate. This has
the potential to make the clog worse and can lead to more clogging in the future. 1

ASSESSMENT AND PLANNING:

Nursing Considerations:
1. The Viokace/sodium-bicarbonate mixture should only be instilled once.
2. Enteral tubing connectors and French gauge vary. For safety reasons, newly placed enteral tubes will have
ENFit connector. These require the use of ENFit syringes designed specifically to fit onto enteral devices.
Ensure you obtain the proper syringe to fit the patient’s enteral tube.

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Resources:
-Personal protective equipment (PPE)/glove, gowns and masks
-Towel(s)
- 35mL or 60mL Enteral Syringe (this may vary based on tubing type of patient)
-Warm tap water

If pancreatic enzyme/sodium bicarbonate solution is to be used gather the following:

-one crushed Viokace 10 tablet (10,440 USP units of lipase)
-one crushed 325 mg non-enteric coated sodium bicarbonate tablet.
-5mL warm tap water
-10 mL or 12 mL Enteral Syringe (this may vary based on tubing type of patient)

IMPLEMENTATION:
Sequence, Intervention/Scientific Rationale:
Steps:
1. Identify patient per Hospital wide policy, “Identifying Patients”, I 09.04.05.12.
2. Explain procedure to the patient and provide privacy and comfort.
3. Wash hands and gather equipment at bedside.
4. Apply appropriate PPE with nonsterile gloves at a minimum, and gown, mask, and eye protection when
indicated.
5. Use towel(s) to protect patient clothing and bedding.
6. Attach syringe to the feeding tube and pull back the plunger to help dislodge the clog.
7. Instill warm tap water into the feeding tube using syringe and apply a gentle back‐and‐forth motion with the
plunger of the syringe to try and clear the clog.
8. If this is unsuccessful in clearing the clog, clamp tube with warm water inside for 5-20 minutes to try and
soften clog.
9. After waiting period reattempt flushing.
10. If water is unsuccessful at unclogging tube, physicians should be contacted for orders for one Viokace 10
tablet (10,440 USP units of lipase) and one 325 mg non-enteric coated sodium bicarbonate tablet.
11. Pharmacy will crush the medication and send to the unit. Wear gloves and a mask when mixing the
Viokace and Sodium Bicarbonate with 5 mL of warm water.
12. Mix the crushed tablets in 5 mL warm tap water.
13. Instill mixture into tubing using small enteral syringe. Allow mixture to soak in the tube for a minimum of
30 minutes up to two hours.
14. Attempt flushing feeding tube with 30 mL to 60 mL warm tap water.
15. If tubing remains clogged and it a gastrostomy tube contact the physician for an order for Endoscopy to
evaluate for a tube replacement.
16. If the tubing remains clogged and it is a jejunostomy tube or it is a gastrostomy tube that has been in place
less than 6 weeks Endoscopy cannot replace the tube. Please contact the attending physician for further
instructions.

DOCUMENTATION:
1. Document the procedure, results, and the patient’s tolerance to the procedure in patient chart.
2. Authenticate all entries in multidisciplinary document record.

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REFERENCES
1. Dandeles, L., & Lodolce, A. (2011). Efficacy of Agents to Prevent and Treat Enteral Feeding Tube
Clogs. Annals Of Pharmacotherapy, 45(5), 676-680. doi: 10.1345/aph.1p487

2. Klang, M., Gandhi, U., & Mironova, O. (2013). Dissolving a Nutrition Clog With a New Pancreatic
Enzyme Formulation. Nutrition In Clinical Practice, 28(3), 410-412. doi: 10.1177/0884533613481477
3. Boullata, J., Carrera, A., Harvey, L., Escuro, A., Hudson, L., & Mays, A. et al. (2016). ASPEN Safe
Practices for Enteral Nutrition Therapy. Journal Of Parenteral And Enteral Nutrition, 41(1), 15-103. doi:
10.1177/0148607116673053
4. Fisher, C., & Blalock, B. (2014). Clogged Feeding Tubes: A Clinician’s Thorn. Pract Gastroenterol, 38(3),
17.
5. Arriola, T., Hatashima, A., & Klang, M. (2010). Evaluation of Extended-Release Pancreatic Enzyme to
Dissolve a Clog. Nutrition In Clinical Practice, 25(5), 563-564. doi: 10.1177/0884533610382785