Understanding Why Feeding Tubes Clog
Feeding tubes can become blocked for several reasons, often related to the administration of formula and medications. The most common culprits include:
- Medication Administration: Pills that are not crushed finely enough or are not properly dissolved can create a thick residue that sticks to the inside of the tube. Certain types of medication, like extended-release or enteric-coated pills, should never be administered via a feeding tube.
- Inadequate Flushing: The most common cause is insufficient flushing. Not flushing the tube with enough water before and after feedings and medication administration allows residue to build up over time, narrowing the tube's diameter until it eventually clogs.
- Formula Buildup: In continuous or bolus feedings, some formula can stick to the tube walls. If not flushed away promptly, this residue can dry and harden.
- Improper Formula Mixing: Mixing different formulas or medications improperly can cause chemical reactions that lead to precipitation and clogs.
- Kinks or Bends: Physical obstructions, such as a kink in the tubing, can mimic a clog. It's always important to check the entire length of the tube first.
The Recommended Method: Warm Water Flush
For most clogs, warm water is the safest and most effective first-line treatment. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends this method.
Supplies Needed:
- A 60 mL syringe (a smaller syringe can apply too much pressure and risk rupturing the tube).
- A cup of warm (not hot) water.
- A clean towel or washcloth.
Step-by-Step Instructions:
- Preparation: Wash your hands thoroughly. Check the entire length of the tube for any visible kinks or clamps that might be causing the issue.
- Initial Attempt: Attach the 60 mL syringe to the feeding port. Pull back on the plunger to attempt to remove as much fluid as possible. This can sometimes dislodge a fresh clog.
- Instill Warm Water: Draw up 15-30 mL of warm water into the syringe. Attach it to the feeding port and gently push the plunger to instill the water into the tube.
- Gentle Pressure: If you feel resistance, apply a gentle push-and-pull motion with the plunger. Do not use excessive force, as this can cause the tube to rupture.
- Let It Soak: If the clog doesn't clear immediately, clamp the tube and allow the warm water to sit for 15-20 minutes to soften the blockage. You can also gently massage the tubing with your fingers if the clog is visible.
- Repeat and Assess: Unclamp the tube and repeat the push-and-pull motion with the syringe. If the clog clears, flush the tube with the normal amount of warm water before resuming feeds or medication.
Advanced Techniques for Stubborn Clogs
If the warm water method is unsuccessful after a couple of attempts, a more advanced solution may be needed. These should only be used if directed by a healthcare professional.
Using an Enzymatic Declogging Agent
Specialized enzymatic products like Clog Zapper are available commercially and work by dissolving the protein or fat buildup. A pancreatic enzyme solution can also be mixed at home under medical supervision.
Process:
- Preparation: Prepare the enzymatic solution as directed by the product or your healthcare provider.
- Instillation: Administer the solution into the tube and allow it to sit for the recommended duration (e.g., 30-60 minutes).
- Flush: After the soaking period, flush the tube with warm water using the gentle push-pull motion.
Mechanical Declogging Devices
For persistent clogs, special devices are available for use by trained healthcare professionals. The TubeClear System, for instance, uses a small, flexible wire with a jackhammer-like motion to break up the clog from the inside. These are typically used in a clinical or emergency setting.
Comparison of Unclogging Methods
| Method | Effectiveness | Speed | Safety | When to Use | Cautions |
|---|---|---|---|---|---|
| Warm Water Flush | High for most initial clogs | Moderate (requires soaking) | Very High | First-line treatment for all clogs | Avoid excessive force; use 60 mL syringe. |
| Enzymatic Agent (e.g., Clog Zapper) | High for protein/formula clogs | Slower (requires soaking) | High (when used correctly) | Clogs resistant to warm water flush | Use only commercial products or medically prescribed solutions; follow directions precisely. |
| Mechanical Device (Professional Use Only) | Very High for stubborn clogs | Fast | Medium (potential for tube damage) | Hospital/clinic setting for unresponsive clogs | Should only be performed by a trained clinician. |
| Carbonated Beverages (e.g., Cola) | Low and Ineffective | Quick but unreliable | Low (can worsen clogs) | Never use | Acidic pH can curdle formula and precipitate more protein. |
Prevention is the Best Strategy
Adopting a consistent and proactive approach to tube care is the best way to avoid blockages altogether.
- Flush Routinely: Flush the feeding tube with 15-30 mL of warm water before and after every feeding, and between each medication. During continuous feeds, flush every 4-8 hours.
- Proper Medication Prep: Whenever possible, use liquid medications. If tablets are necessary, crush them to a very fine powder and mix thoroughly with water before administering.
- Use Proper Syringe Size: Always use a 60 mL syringe for flushing. Smaller syringes can generate too much pressure and damage the tube.
- Separate Medications: Administer each medication separately, flushing with water in between.
- Inspect and Replace: Regularly inspect the tubing and connections for signs of wear and tear. Replace extension sets and tubes as recommended by your healthcare provider.
Conclusion
A clogged feeding tube can be a stressful and urgent issue, but in many cases, it can be resolved safely at home with the right technique. The first and most important step is always to try flushing with warm water using a 60 mL syringe and gentle pressure. If this fails, specialized enzymatic cleaners or mechanical solutions may be necessary under medical supervision. The key to long-term success, however, lies in prevention. Regular, proper flushing and careful medication preparation are the most effective ways to keep the tube clear and ensure uninterrupted nutrition and care. If a clog persists or if you are ever unsure, always contact your healthcare provider for guidance. Never attempt to force a clog, use unapproved substances like soda or juice, or insert unapproved tools, as this can cause serious damage to the tube and patient.
What to Do If You Can't Fix the Clog
If you have followed the warm water protocol and the tube remains clogged, do not panic and do not continue to force it. Contact your healthcare provider or home health nurse for next steps. They may recommend using a specific enzymatic declogger or having the tube professionally cleared or replaced in a clinical setting.
Note: This information is for guidance and does not replace medical advice. Always consult with a healthcare professional before attempting to fix a clogged feeding tube.
Visit the Medline blog for additional resources on troubleshooting feeding tube clogs.
