Nutrition Support Blog: So Close, but So Clogged
October 24, 2012
In Greek mythology Tantalus was punished for heinous and gruesome deeds by having to spend eternity with food and drink very near, but perpetually just beyond his reach. I imagine that Tantalus would meet criteria for severe malnutrition.
I empathize with the frustration that Tantalus may have felt when I have a patient that finally achieves needed enteral access, only to have the small bore feeding tube clogged several hours (or days) later! It also seems like those patients with the largest nutrition deficit, or those with the most difficult to place tubes, are those that are most likely to clog!
A number of different methods to prevent or treat clogged small bore feeding tubes have been described. The most obvious and practical way to prevent clogged tubes is adequate water flushes, especially when the feedings are held for any length of time or medications are delivered. However, the search for something more effective than water for unclogging a feeding tube most likely started shortly after the first small bore feeding tube was inserted!
I have seen cranberry and other juices, ginger ale and of course, at the bedside, cola beverages are often treated as a “universal solvent”. Unfortunately, the available data suggests that juices and carbonated drinks are not significantly better than just plain water, and in some cases may be worse than water.
In recent years there have been several potentially more effective methods for unclogging feeding tubes reported, including meat tenderizer, pancreatic enzymes, commercial products with surfactants plus enzymes and several commercial brush or catheter type devices. A recent article discusses a number of different methods used to declog feeding tubes and reviews much of the data comparing different methods to resolve tube occlusion (1).
One new product not mentioned in the review article is a device called TubeClear, made by Actuated Medical: http://www.tubeclear.com/
TubeClear appears to use a micropercussive actuator at the end of catheter to mechanically break up a feeding tube clog. The product’s website reported that TubeClear was approved for use with NG feeding tubes in June 2012, so I suspect we will be hearing more about it in the near future.
We will be looking forward to published data on effectiveness and costs of this device, because we are interested in anything that will help reduce the barriers to getting adequate nutrition into our patients, whatever they are. I guess there were no nutrition support professionals in ancient Greece…or at least none in the lowest reaches of the underworld, because I think they would have found a way to get Tantalus fed, no matter what he did….
1) Dandeles LM, Lodolce AE., Efficacy of agents to prevent and treat enteral feeding tube clogs. Ann Pharmacother. 2011 May;45(5):676-80. Epub 2011 Apr 26.
“…I'll be ever'where—wherever you look. Wherever they's a fight so hungry people can eat, I'll be there….”
- John Steinbeck, (Tom Joad, The Grapes of Wrath, 1939)