Download guidelines for clearing a blocked enteral feeding tube using

GUIDELINES FOR CLEARING A BLOCKED ENTERAL FEEDING TUBE
USING PANCREATIC ENZYMES
PURPOSE
To describe the procedure for use of a solution of pancreatic enzyme and sodium bicarbonate to treat clogged
enteral feeding tubes.
POLICY STATEMENTS
Prevention is the key factor in the management of enteral feeding tube occlusion. Adequate amounts of sterile
water flushes should be used every 4 hours or before and after tube feeds and medication administration. To
prevent tube clogging due to medication administration, liquid formulations should be used whenever possible.
If an occlusion does occur, water should be used first due to proven efficacy and no risk of adverse effects.
Use of beverages such as carbonated soda and cranberry juice is not recommended because of the risk of
worsening the clog and lack of evidence of efficacy.
The use of pancreatic enzyme/sodium bicarbonate solution to treat a clogged enteral feeding tube requires a
prescriber order. The order must specify drug name, dosage, route and indication.
SITE APPLICABILITY
Applicable to all areas where patients with feeding tubes are cared for.
PRACTICE LEVEL/COMPETENCIES
The practice of compounding pancreatic enzyme/sodium bicarbonate solution and instilling solution into a
feeding tube to attempt to clear an occlusion is a foundational level nursing competency.
EQUIPMENT
o
o
o
o
o
Pancreatic enzyme capsule: non-enteric coated (e.g. Cotazym plain)
Sodium bicarbonate - 4 mL 8.4% solution
Warm water (Sterile water for neonates, infants under 1 year and for critically ill or
immunocompromised patients)
60 mL syringe
med cup
PROCEDURE
Rationale
1. CHECK chart for prescriber’s order.
Requires prescriber order.
NOTE: usual dosage is 1 pancreatic enzyme capsule
(e.g. Cotazym®) with 325 mg sodium bicarbonate (= 4
mL 8.4% sodium bicarbonate solution).
2. ASSEMBLE equipment.
Facilitates completion of procedure in a timely manner.
3. IDENTIFY patient and EXPLAIN procedure.
Failure to correctly identify patients prior to procedures
may result in errors.
Reduces child and family’s anxiety. Evaluates and
reinforces understanding of previously taught
information and confirms consent for procedure.
4. PERFORM hand hygiene.
Routine infection control practices; reduces transmission
of microorganisms.
5. ATTEMPT to clear tube with warm water using a Warm water has been shown to be efficacious in
60 mL syringe and firm pulling and pushing action. clearing most enteral tube occlusions.
If unsuccessful, attempt to aspirate as much of the
contents as possible.
6. PLACE the contents of an opened pancreatic
Sodium bicarbonate is required to activate the
enzyme capsule into a med cup and ADD 4 mL
pancreatic enzyme.
sodium bicarbonate 8.4% solution and dissolve
LastReviewDate
BC Children’s
Jun 11, 2013CC.12.25
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Dec
Health
Policy and Procedure Manual
01, 2001
Page 1 of 2
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Nov 02, 2016 08:34
Generated By
Anonymous
GUIDELINES FOR CLEARING A BLOCKED ENTERAL FEEDING TUBE
USING PANCREATIC ENZYMES
pancreatic enzyme thoroughly. Additional warm
water may be added if required.
Contact with the occlusion is required to dissolve it.
7. DRAW up the dissolved solution into the 60 mL
syringe and instill it into the tube. CLAMP the tube
for 5-15 minutes. MILK the tube to get solution as
close as possible to blocked area.
8. UNCLAMP tube and attempt to flush again with
warm water (sterile water for neonates, infants
under 1 year and for critically ill or
immunocompromised patients) and firm pulling
and pushing action. If the tube remains occluded,
repeat above steps, leaving the solution dwell for
up to one hour.
9. If two attempts do not clear the tube then it most
likely will need to be replaced. CONSULT with the
physician for possible replacement of the tube.
10. REMOVE and DISPOSE equipment appropriately. Routine infection control practices; reduces transmission
PERFORM hand hygiene.
of microorganisms.
DOCUMENTATION
DOCUMENT on appropriate record:
o
date and time
o
assessment of occlusion
o
medications and doses
o
amount of water flush (if fluid restricted)
o
response to the procedure (i.e. was the tube cleared?)
o
any other pertinent actions or observations
REFERENCES
Bourgault, A.M., Heyland, D.K., Drover, J.W., Keefe, L., Newman, P. and Day, A.G. (2003). Prophylactic
pancreatic enzymes to reduce feeding tube occlusions. Nutrition in Clinical Practice, 18(5):398-401.
Dandeles, L.M. and Lodolce, A.E. (2011). Efficacy of Agents to Prevent and Treat Enteral Feeding Tube Clogs.
The Annals of Pharmacotherapy, 45:676-680.
Krishnan, S., Jayanthi, V., Lakshmi, R.G. and George, V.S. (1997). Prophylactic Locking of Enteral Feeding
Tubes with Pancreatic Enzymes. Journal of Parenteral and Enteral Nutrition, 21 (6):353-356.
Marcuard, S.P. and Stegall, K.S. (1990). Unclogging feeding tubes with pancreatic enzyme. Journal of
Parenteral and Enteral Nutrition, 14(2):198-200 .
Merck Manual Medical Library: The Merck Manual of Diagnosis and Therapy. Pancrelipase drug information
provided by Lexi-Comp. April 2013. Retrieved from
http://www.merck.com/mmpe/print/lexicomp/pancrelipase.html
Reising, D.L. and Neal, R.S. (2005). Enteral Tube Flushing: What you think are the best practices may not be.
American Journal of Nursing. 105(3):58-63.
LastReviewDate
BC Children’s
Jun 11, 2013CC.12.25
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Dec
Health
Policy and Procedure Manual
01, 2001
Page 2 of 2
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Nov 02, 2016 08:34
Generated By
Anonymous