Educating your Patients about Tube Maintenance
Patients have better things to do than deal with clogged feeding tubes, which can be responsible for lost delivery of feeds in addition to increased risks and costs for tube replacement. Teaching patients how to prevent clogs and perform feeding tube maintenance can help avoid the trouble in the first place.
Estimates (1) put clogged feeding tubes between 12.5% to 45% over the life of a tube. And in addition to associated risks, a single clog could cost more than $1,000 to replace in the hospital. Worse, your patients may get wind of Internet declogging remedies and could try a dangerous DIY home declog method using things like cranberry juice, cola, meat tenderizer or pipe cleaners, which are not only ineffective but possibly unsafe. You can help patients avoid this.
The best way to help your patients manage a clog is to teach them prevention, but if clogging does occur, it is important that you have armed them with methods of restoring tube patency.
"a single clog could cost more than $1,000 to replace in the hospital."
Effective Declogging Methods
- 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 require a prescription, and Clog Zapper, an available commercial product. All other brands of enzymatic dissolvers are enteric coated and cannot be used for declogging.
- 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.
While patients can’t always prevent clogs, a few methods of prevention may be worthwhile to pass on including:
- 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.