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|Tube Feeding Tips: Solutions for a Clogged Tube|
Products to Help with Clogged Tubes
If your feeding tube is clogged, the first step is to try flushing with warm water. When that doesn’t work, your clinician has some new tools available to resolve the issue. Further advice on preventing and treating clogged tubes can be found in Oley’s Tube Feeding Troubleshooting Guide. Note: these methods should not be used with intravenous lines.
This solution to clogged G- and J-tubes relies on the action of a pancreatic enzyme and sodium bicarbonate, and is recommended when a feeding tube is blocked by nutritional formula. Viokace® (Aptalis Pharma) is the only pancreatic enzyme recommended for this off-label use because it does not have an enteric coating (a substance on the outside of medication designed to prevent the medication from dissolving in the stomach). An enteric coating may prevent the enzyme from dissolving the clog, and end up clogging the tube further.
Viokace is available by prescription, and the following method is recommended for use by clinicians only. Note: if the clog is not made of formula, the enzyme may not dissolve the clog and may leave a gummy residue that can increase the size of the obstruction. Also, use caution when clearing small-bore tubes, as tablet fragments may further complicate the clog. Viokace contains lactose monohydrate, which may not be tolerated by patients with lactose issues.
Method: wearing gloves and a mask, crush one Viokace tablet (10,440 USP units of lipase) and one 375 mg sodium bicarbonate tablet, and mix in 5 mL of water. Introduce the mixture into the clogged tube, clamp, and let dwell for at least 30 minutes. (The mixture can be introduced with a syringe; or if the clog is further down the tube, it can be introduced with a small-bore PVC tube inserted into the feeding tube.) Next attempt to flush the tube with warm water. If the clog is not cleared, the old Viokace mixture should be removed from the tube and replaced with a fresh batch.
Many thanks to Mark Klang, MS, RPh, BCNSP, PhD, for sharing his research. (Klang, M. et. al.,  Dissolving a Nutrition Clog With a New Pancreatic Enzyme Formulation. Nutrition in Clinical Practice, 28, 410-411.)
The Clog Zapper™ (Corpak MedSystems) uses a patented, food-grade powder that the manufacturer calls an “enzyme cocktail” (with acids, buffers, anti-bacterial agents, and metal inhibitors) to clear blocked tubes. It comes premeasured and loaded in a ready-to-use system, and is approved for use with G-, J-, NG-, and NJ-tubes as well as low-profile devices.
This powder “cocktail” is mixed with water in a syringe and agitated for 5–7 minutes. The solution is dispensed through a narrow-bore applicator tube which is placed into the feeding tube. Once the solution is instilled wait 30–60 minutes. Take a separate syringe with water and flush the tube to relieve the obstruction. It is recommended that the first time you try the Clog Zapper you do so under a clinician’s supervision.
This solution to clogged tubes relies on mechanical cleaning action (like snaking a clogged drain) and can be used by a clinician to clear different types of substances that may block a G-, J-, NG- or NJ-tube. The TubeClear (Actuated Medical, Inc.) electronic control box feeds disposable “stems” (like miniature bottle brushes) into a feeding tube. Once the stem reaches the blockage, an automated in-and-out motion is used to clear the obstruction through vibration. Often the stem is fed more than once, and water may be inserted and/or loosened clog contents may be aspirated to assist the clearing process.
TubeClear can only be used if the clinician knows for certain the type, size, and length of the feeding tube. Potential injury to the gastrointestinal tract (ulceration, bleeding, and very rarely, perforation) may occur if the device is inserted beyond the distal end of the feeding tube. The clinician must verify that the tube is still properly placed after the procedure.
This device is approved for use by the U.S. Food and Drug Administration (FDA) and is currently undergoing clinical trials, but results have not yet been published in a peer-reviewed journal.
The DeClogger is a thin, flexible, polypropylene rod that has a spiral tip on one end and a handle on the other. It comes in two different lengths and five widths (French); each size is a distinct color. The rods are marked along their length to prevent over-insertion. As with other mechanical tube-clearing devices, the clinician must know the type, size, and length of the feeding tube. Potential injury to the gastrointestinal tract (ulceration, bleeding, and very rarely, perforation) may occur if the device is inserted beyond the distal end of the feeding tube. There is also a chance that the tube itself may be damaged.
The DeClogger is designed to be inserted into the tube, then gently twisted. When twisted, the screw-thread design of the DeClogger allows it to bore through and loosen a clog. It is available only on the order of a clinician.
Oley member Errol Childress writes, “I love the DeClogger. You screw the rod into the tube, pull out the clog, then flush. So simple to use!”, including his advice to follow manufacturer’s “single-use” recommendation and to loosen any tube securement device before using.
PEG Cleaning Brush
Bard manufactures brushes that are made specifically for cleaning PEG tubes. The brush is designed for daily or weekly cleaning of tubes 20 French or larger; it is not designed to loosen clogs. It has a brush tip (feather mounted to help “minimize the risk of mucosal injury”) on a nylon shaft, with a luer hub so fluids can be injected into the tube simultaneous with the brush. Potential injury to the gastrointestinal tract (ulceration, bleeding, and very rarely, perforation) may occur if the device is inserted beyond the distal end of the feeding tube. There is also a chance that the tube itself may be damaged.
LifelineLetter, March/April 2014