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quality when combined with formula proteins may actually
contribute to tube clogging.
General Flushing Guidelines
• Use a 30 to 60 cc catheter tip syringe. Do not use smaller
size syringes as this can increase pressure on the tube
and potentially rupture smaller tubes.
• Use room temperature tap water for tube flushing. Sterile
water may be appropriate where the quality of municipal
water supplies is of concern. The amount of water will
depend on the patient's needs, clinical condition, and type
of tube, but the average volume ranges from 10 to 50 mls
for adults, and 3 to 10 mls for infants. Hydration status also
influences the volume used for flushing feeding tubes.
In many cases, increasing the flushing volume can avoid
the need for supplemental intravenous fluid. However,
individuals with renal failure and other fluid restrictions
should receive the minimum flushing volume necessary to
maintain patency.
• Do not use excessive force to flush the tube. Excessive
force can perforate the tube and can cause injury to the
gastrointestinal tract.
• Document the time and amount of water used in the
patient's record. This will enable all caregivers to monitor
the patient's needs more accurately.
Daily Care & Maintenance Check List
Assess the patient
Assess the patient for any signs of pain, pressure or
discomfort.
Assess the stoma site
Assess the patient for any signs of infection, such as
redness, irritation, edema, swelling, tenderness, warmth,
rashes, purulent or gastrointestinal drainage. Assess the
patient for any signs of pressure necrosis, skin breakdown
or hypergranulation tissue.
Clean the stoma site
Use warm water and mild soap.
Use a circular motion moving from the tube outwards.
Clean sutures, external bolsters and any stabilizing devices
using a cotton-tipped applicator.
Rinse thoroughly and dry well.
Assess the tube
Assess the tube for any abnormalities such as damage,
clogging or abnormal discoloration.
Clean the feeding tube
Use warm water and mild soap being careful not to pull or
manipulate the tube excessively.
Rinse thoroughly, dry well.
Clean the gastric and balloon ports
Use a cotton tip applicator or soft cloth to remove all
residual formula and medication.
Rotate the tube
Rotate the tube 360 degrees plus a quarter turn daily.
verify placement of the external bolster
Verify that the external bolster rests 2-3mm above the skin.
Flush the feeding tube
Flush the feeding tube with water using a catheter tip or
slip tip syringe every 4-6 hours during continuous feeding,
anytime the feeding is interrupted, or at least every 8 hours
if the tube is not being used. Flush the feeding tube after
checking gastric residuals. Flush the feeding tube before
and after medication administration. Avoid using acidic
irrigants such as cranberry juice and cola beverages to
flush feeding tubes.
Balloon Maintenance
Check the water volume in the balloon once a week.
• Insert a Luer slip syringe into the balloon inflation port
and withdraw the fluid while holding the tube in place.
Compare the amount of water in the syringe to the amount
recommended or the amount initially prescribed and
documented in the patient record. If the amount is less
than recommended or prescribed, refill the balloon with
the water initially removed, then draw up and add the
amount needed to bring the balloon volume up to the
recommended and prescribed amount of water. Be aware
as you deflate the balloon there may be some gastric
contents that can leak from around the tube. Document the
fluid volume, the amount of volume to be replaced (if any),
the date and time.
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STERILIZE
• Wait 10-20 minutes and repeat the procedure. The balloon
is leaking if it has lost fluid, and the tube should be
replaced. A deflated or ruptured balloon could cause the
tube to dislodge or be displaced. If the balloon is ruptured,
it will need to be replaced. Secure the tube into position
using tape, then follow facility protocol and/or call the
physician for instructions.
NoTE: Refill the balloon using sterile or distilled water,
not air or saline. Saline can crystallize and clog the
balloon valve or lumen, and air may seep out and cause
the balloon to collapse. Be sure to use the recommended
amount of water as over-inflation can obstruct the lumen
or decrease balloon life and under-inflation will not secure
the tube properly.
Tube occlusion
Tube occlusion is generally caused by:
• Poor flushing techniques
• Failure to flush after measurement of gastric residuals
• Inappropriate administration of medication
• Pill fragments
• Viscous medications
• Thick formulas, such as concentrated or enriched formulas
that are generally thicker and more likely to obstruct tubes
• Formula contamination that leads to coagulation
• Reflux of gastric or intestinal contents up the tube
To Unclog A Tube
1. Make sure that the feeding tube is not kinked or clamped
off.
2. If the clog is visible above the skin surface, gently massage
or milk the tube between fingers to break up the clog.
3. Next, place a catheter tip syringe filled with warm water
into the appropriate adaptor or lumen of the tube and
gently pull back on then depress the plunger to dislodge
the clog.
4. If the clog remains, repeat step #3. Gentle suction
alternating with syringe pressure will relieve most
obstructions.
5. If this fails, consult with the physician. Do not use
cranberry juice, cola drinks, meat tenderizer or
chymotrypsin, as they can actually cause clogs or create
adverse reactions in some patients. If the clog is stubborn
and cannot be removed, the tube will have to be replaced.
Balloon Longevity
Precise balloon life cannot be predicted. Silicone balloons
generally last 1-8 months, but the life span of the balloon
varies according to several factors. These factors may
include medications, volume of water used to inflate the
balloon, gastric pH and tube care.
Warning: For enteral nutrition and/or medication only.
For more information, please call 1-800-KCHELPS in the United
States, or visit our web site at www.kchealthcare.com.
Educational Booklets: "A Guide to Proper Care" and "A
Stoma Site and Enteral Feeding Tube Troubleshooting
Guide" is available upon request. Please contact your local
representative or contact Customer Care.
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