Preventing and managing enteral feeding tube blockages

Preventing blockages

Prevention is the most effective strategy.

Regularly flush enteral feeding tubes with water and follow local medicine administration protocols to reduce the risk of a blockage.

Managing blocked enteral tubes

Clear any tube blockages as soon as possible. 

How a tube is unblocked depends on what is blocking the tube.

If available, follow your local guidelines on the management of enteral tube blockages.

If the tube is blocked by medication, the medication should be reviewed to reduce the risk of further blockages.

We discuss which formulations of medicines can block enteral feeding tubes in our article Choosing medicines for enteral tube administration

Irrigating with liquids

This is the preferred management method. 

Warm water irrigation is considered first line. Sodium bicarbonate irrigation is second line. 

If the tube is still blocked, consider the off–label use of pancreatic enzymes. 

Warm water

Use lukewarm water (40 to 45°C). Do not use boiling or hot water to flush an enteral feeding tube.

1. Draw up 15 to 30 mL of lukewarm water in a 60 mL ENFit enteral syringe
2. Using a gentle push and pull technique, attempt to flush and withdraw the fluid from the tube
3. Allow at least 30 minutes for this process

Sodium bicarbonate

1. Open 4 sodium bicarbonate 500mg capsules
2. Dissolve the capsule contents in 50mL of sterile water
3. Draw up the 50 mL of dissolved solution in a 60 mL ENFit enteral syringe 
4. Using a gentle push and pull technique, attempt to flush and withdraw the fluid from the tube
5. Allow at least 30 minutes for this process

Pancreatic enzymes

The use of pancreatic enzymes for clearing tube blockages is off-label.  

Pancreatic enzymes are only effective if the blockage is caused by feed protein; it is not used for blockages caused by medicines. 

The use of pancreatic enzymes to dissolve feeding tube blockages has been studied with varying results, and local protocols may differ. Follow your local guidelines, where available. 

The following dosages have been reported in the literature. 

Pancrex V method

1. Open 3 Pancrex V capsules
2. Mix the capsule contents with 1g of sodium bicarbonate powder in 20mL distilled water
3. Draw up the 20 mL solution in a 60 mL ENFit enteral syringe 
4. Instil the solution into the enteral feeding tube
5. Leave the solution in the tube for 20 minutes and allow it to dissolve the blockage
6. Flush with distilled water

Creon method

1. Open and dissolve the contents of 4 sodium bicarbonate 500mg capsules in 50mL of sterile water
2. Open 1 Creon 10,000 capsule
3. Crush the granules and place them in the 50 mL sodium bicarbonate mixture
4. Draw up the 50 mL solution in a 60 mL ENFit enteral syringe
5. Instil the solution into the enteral feeding tube
6. Leave the solution in the tube for 20 minutes and allow it to dissolve the blockage
7. Flush with distilled water

Replacement

If all the above methods are unsuccessful, do not use any other methods to unblock the tube. 

Contact the relevant specialists, such as the community nurses, as the enteral feeding tube will likely need to be replaced.

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