In the acute care facility where I work, many nurses use carbonated beverages, especially ginger ale, when they attempt to unclog nasogastric feeding tubes. What's the best evidence-based practice for unclogging feeding tubes in adults?—K.P., CONN.
Kimberly Drummond Hayes, BS, RN, and Denise Drummond Hayes, MSN, RN, CRNP reply: Each year, about 250,000 hospitalized patients receive enteral nutrition (EN) through an enteral access device (EAD).1 Short-term nasoenteric EADs are used in many patients who are critically ill and who have insufficient oral intake. Unfortunately, these feeding tubes are prone to clogging due to factors such as EN formula composition, small internal feeding tube diameters, tube lengths, inadequate water flushes, gastric residual volume measurements, and improper medication preparation and administration.1,4 A clogged feeding tube can delay administration of nutrients, hydration, and medications to patients.
Tube occlusion is more easily prevented than corrected. Consult with a pharmacist to ensure the patient's medications are compatible with the EN formula and that formula and medications can be cleared from the tube with adequate flushing.6 Perform routine flushing with 30 mL of water every 4 hours, before and after medication administration, and after any interruption of EN. Use at least a 30-mL syringe to prevent tube rupture.1-5
If the patient's feeding tube becomes clogged, attempt to unclog it before replacing it, which is both costly and uncomfortable for the patient. Belief that carbonated beverages or cranberry juice will unclog a feeding tube is a persistent nursing myth. In fact, these beverages have an acidic pH that can worsen the occlusion by causing proteins in the EN formula to precipitate within the tube.1,3
Follow your facility policy and procedure for unclogging EADs. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends warm water as the best initial choice for trying to unclog a feeding tube. First, attach a 30- or 60-mL piston syringe to the feeding tube and pull back the plunger to help dislodge the clog. Next, fill the flush syringe with warm water, reattach it to the tube, and attempt a flush. If you continue to meet resistance, gently move the syringe plunger back and forth to help loosen the clog. You can then clamp the tube to allow the warm water to penetrate the clog for up to 20 minutes.
If water fails to unclog the tube, ASPEN guidelines recommend using an activated pancreatic enzyme solution.1-4 However, use of a pancreatic enzyme solution requires a healthcare provider's prescription and should be attempted only by nurses familiar with the procedure according to facility policy and procedure.3
Additional second-line interventions include using a commercially available enzyme declogging kit or mechanical declogging device. These also must be used in accordance with facility policy and procedure and only by experienced clinicians. If the tube can't be unclogged by these methods, ASPEN recommends replacing it.1,2,4
Consistently flushing feeding tubes with water as scheduled during EN therapy and medication administration is the best way to minimize the risk of occlusions.1 Nurses need ongoing education about assessing and caring for patients with an EAD, including scheduled flushing with the correct amount of water, responding to a feeding pump occlusion alarm as quickly as possible, properly administering medications through an EAD, and using only recommended EAD declogging procedures.
1. Boullata JI, Carrera AL, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr
2. McClave SA, DiBaise JK, Mullin GE, Martindale RG. ACG clinical guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol
3. University of Pittsburgh Medical Center Presbyterian Shadyside Procedure. Unclogging Enteral Feeding Tubes
. Pittsburgh, PA: University of Pittsburgh Medical Center; 2017.
4. Lord LM. Maintaining hydration and tube patency in enteral tube feedings. Safe Pract Patient Care