Feeding Tube Problems

[moomoo111]

I work in a nursing home, LTC. I have a resident that has a peg tube. It continues to get clogged. We even sent her to the ER to have something done because no-one could flush it. When you try to flush it, it just won't go. We have tried coke, sprite, pepsi, at the doctor's request and it just would not flush. It has a Y port so when you try to force it, we get sprayed. Another nurse that worked in LTC for years, told me it may be the meds we are putting in the tube and to flush with cranberry juice after the meds. The ER doctors manipulated it and said it had a kink in it and he straightened it out. They won't change it and I don't know why. She is only on Osmolite 1.5 at 40cc/hr continous. We are flushing the tube every two hours with 100 cc of water but it keeps getting clogged. I was reading some facts on line and one place said if it had a Y port to use the side port to flush. I mix the meds with warm water and disolve them real good before I flush. She is on trazadone at night and some bp meds during the day. Not a lot of meds. And liquid vitamin supplements, just 15 cc of that. Any suggestions would be great. Could it be that the rate is too slow or too much? The other night right after I flushed her, she started having chest pain and I called the doctor and he said to send her to the ER. After that, I went back to the room and she was projectile vomiting and she vomited a piece of Osmolite in the shape of the tube that looked like about a five inch piece of spaghetti. It was Osmolite and it was very hard to break off. It was soft, not hard like a finger nail, it was just like old dried up spaghetti. I sent it in a bag with the ambulance crew. They sent her right back and said it was nothing and to flush it with a 2 liter pepsi!! I said "my gosh, you are going to blow her up with all that"! So of course I did not. I tried the cranberry juice last night and it was flushing fine this morning when I left. Please tell me your opinions on what could be going on. She has some sort of mass in her lower abdomen, not sure if it's pancreas, gall bladder, colon, but it's in operable. I'll try to find out exactly what that is and get back to you on that one. That could be something to consider also. Thanks for your help. Moo Moo I'm an LPN by the way. Rn's have tried different things also. It's a Kangaroo pump, if that means anything.

[caliotter3]

I've seen less problems when feeding tubes are changed at regular intervals and PRN.

[RedhairedNurse, BSN, RN]

It sounds like to me she may be going a long time without it being flushed. I know the nurses are suppose to do it q shift, but some do not.

[morte, LPN, LVN]

perhaps she hasnt enough stomache acid to break down the feeding? and since she vomited, i would think that perhaps that mass is now obstructing.....you said operable, did you mean that or INoperable?....I would double check with the pharmacy about all of her meds being "crushable"....try giving them one at a time with a flush in between.....the fact that she vomited up that "piece" of feeding makes me think that someone may be leaving the feeding turned off at some point during the day.......good luck

[Straydandelion]

It has been hospital protocol where I worked to flush with cranberry juice. It also might help if you can get all the meds in liquid form (some nurses not crushing as well as they could) *shrugs*.

[morte, LPN, LVN]

had another thought.....if you are checking for residual, make sure you are flushing after reinstilling the stomache contents....the feeding is going so slowly that it may be sitting in the tube too long ....

[nerdtonurse?, BSN, RN]

She sounds like a case of aspiration pneumonia waiting to happen. I'd be charting on lung sounds and bowel sounds like crazy. Is the pt a DNR, I hope? Has she had the PEG a long time?

What I would suggest is take a permanent marker, and next time she comes back from the ER with a patent and flushing tube, mark the spot where the tube goes into the body. I had a pt who would flush, then not flush, and it was driving me nuts, until I looked and though, "gee, doesn't this tube look shorter?" Endo got her tube straightened out, I marked the length, and guess what? In the middle of the night, the line had disappeared. She was actually pulling in the tube, and that was making the tube kink. Called the doc, they changed to a larger tube, (which I still marked), and no more problem.

[scg08rn]

Gingerale as well works. I would probably talk to the dietician/doctor about changing her feeding, unless contraindicated. Some of these feedings are very thick. I have that problem sometimes, with my bolus feeding of jevity 1.5, I usually try to "milk" what is stuck in the tube with warm water. Some nurses just don't flush as much as they should. Perhaps addressing this to your manager or previous nurses who care for that patient would help. Did the pump every say "No Flow" or anything? If the tube was stuck/kinked, the pump usually alerts you.

[RNAnnjeh, MSN, CNS]

We use cotazyme to unblock a tube in worst-case scenarios---no more using pop (sodas).

Also, sometimes flushing with warm water helps to move any formula that may be stuck in the tube.

However, if this remains an ongoing issue, and flushing isn't the problem then I'd be pushing for a tube change.

[NotReady4PrimeTime, RN]

Another thing that might work is to mix some of her free water into her feeds to decrease the viscosity of it. She's getting 1200 mL of water a day so some of it could be added to the feed and the rate increased. Let's say you went to 960 mL of feed and 600 mL of water per day... you could then run your pump at 65 mL/hr, which isn't a huge volume but is considerably faster than your current rate of 40 mL/hr. 50 mL per flush should be adequate, especially if you use a pulsing method to do the flush so that it moves stuff around in the tube more.

[southernbeegirl, BSN, RN]

you could try changing the end with the Y port to just a single port.

i use hot water to unstop tubes and have never not been able to get one.

it seems more and more lately i am seeing those tiny peg tubs being put in with like a 12fr. what the heck are the docs thinking???

we had a guy that was doing just like your patient. constantly stopped up. we finally got our doc to write an order to schedule him for outpatient appt to get the tube changed to a larger tube. he came back with a #20fr and we AND he were so happy! would your doc do that for yall?

[NotFlo]

1. The tube needs to be changed. It is very unfortunate that the docs have been unwilling to change the darn thing thus far.

2. I have seen these "spaghetti strands" before. The people I have had who are getting constantly clogged, I have a technique for. I take off the stopcock/top part if it's removable at all. Then I use something like a pen or highlighter, or even the flat part of a key (I know, I know everyone is probably horrified at this point, just wait, it gets better) secure the tube at the entry point into the abdomen with my non-dominant hand, then start kind of "stripping" it from the base (closest to the body) to the end. Very gently. What will come out of the tube is a huge long snake AKA "spaghetti strand". After I remove that I give the tube a flush with very warm water using a pulsation technique. I've never had one that I couldn't unclog with that technique.

Don't try this at home!