Feeding Tube Problems

Nurses General Nursing

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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.

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 ....

It sounds like you are doing all you know to do. The shell of the med does not desolve and will cause a clog in the tubes if you don't know how to mix and pur it right. Clogs are common and it sounds like you have been doing everything and and all you know what to do. Sometime tubes do need to be replaced even with the best maintence.

I do not know the real answer to the problem you are having - as they say ask the the doctor. I also do know strange things happen and with older tubers - you never know what is going to happen, or what to do. You just deal with it - do the best you can and consult with the doctor. Crash tubers are not fun.

It has been ages since I've seen a clogged tube.

Def needs a tube change. How old is is? What does the tube look like? Push the family/ pt to get the tube changed.

The cranberry "juice" we get is more of a cran drink....very little acid.

Specializes in medical/telemetry/IR.

how long has she had the tube?

I work in IR where we put the tubes in. The docs put I think a 12 or maybe its a 16 french in to start then they come back later-month? to upsize tube.

sounds like she needs tube change and a upsize.

couldn't you'll send her to your IR to evaluate tube? ER wouldnt really know what to do. at least ours doesn't they just send them to us.

We have sent this poor woman to the ER so many times. They send her back saying there is no doctor there to change the tube. This lady's family finally requested that the tube be taken out since she was eating. They took it out and found that 1., the tube was too small which is what we kept telling them, she was getting too much feeding, rate was too high with her eating too, and 2. there was a broken off q-tip in the tube causing a blockage! The lady has since been released to home without her feeding tube and is doing well. Thanks for your help. moo

Specializes in Nurse Scientist-Research.

When I worked with chronic adults, we were allowed to use meat tenderizer for sluggish or clogged tubes. But I wouldn't use it if your facility's MD's aren't aware of it. It is supposed to gently "digest" the plugs which sounds like what your patient was vomiting up.

What your patient really needs is a new tube. The PEGS I used to work with were super simple. We could pop off the Y adapter, hold the tube at the base where it went into their skin, then gently strip the clogs away from the patient. Of course we couldn't strip the part inside the patient but, that usually worked. That, and once the "track" was healed, an MD could change the normal PEG tube out with a 20F Foley cath and they almost never clogged. But for those things you will need cooperation from the MD.

FWIW, one of my co-workers back then swore that only diet pepsi worked to unclog tubes. I don't know about that, but it was safer since so many of our patients tended to have high glucose levels.

One more thing. I forget the formula you mentioned the patient being on, but I think you added 1.5 to it, I guess indicating it's a 1.5cal/ml formula, but if you are flushing with 100mls of water every 2 hours, there is no point in giving concentrated (more than 1cal/ml) formula. The patient might as well be getting more standard 1cal/ml formula. Sorry for the "formula" references, been working with babies quite a while.

Try gently stripping, milking or rolling the tube between your fingers as you flush with warm water, feedings tend to build up on the inside of the tube (you can see it on the clearer tubes), if they come off in too much of a hurry they will plug the tube.

Consider switching to the the Kangaroo Entriflush (love it but is expensive) or the Kangaroo 524 pump.

The Bionix DeClogger is an inexpensive declogging option and can be used as a preventitive measure. http://www.bionix.com/pages/DecFeatures.html

(Personally I think it's a faster and more cost effective option over the others in the article posted below.)

This is a good article on the causes and management of tube clogs. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=142656

My personal experience is that cocktailing meds -mixing them all together- is a huge part of the problem. Many nurses refuse to believe it ("they all mix together in the stomach anyway") and are resistive to the practice of administering meds one at a time and flushing in between. Just because multiple meds seem to mix well in a cup doesn't mean they don't inter-react with the formula residue that coats the inside of the tube. There is a reason why administering meds one at a time and flushing in between is the standard of care in many areas.

Specializes in ..

^^ I was going to mention the specialized declogging products! I work with children who have long term gastrostomy feeding tubes and I was going to suggest the following, though I'm almost 100% that you were covering these things -

- 2hrly flushes with water

- Flush between each medication

- Medication to go through the tube, NOT the button

- Medication to be exceptionally well crushed and liquidated before pushing

- Reassessing the density of the feed - perhaps changing to a more fluid/less thick feed and/or watering the feed down to ease the flow

- Venting the tube to relieve pressure in the stomach before feeds

- Regular water boluses

I'm curious - if the tube was removed because she was eating etc then why did it stay in for so long in the first place if she could maintain her weight and nutritional status without it?

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