Clogging can be reduced by flushing the tube with 20-30 mL of warm water:
(1) every 4 hours during continuous feedings
(2) before and after intermittent feedings
(3) before and after administration of each medication
The first thing to do if the tube clogs is to try to determine why this occurred, so that it can be avoided in the future.
The second step is to try flushing the tube with warm (not cold) water. Acidic fluids should be avoided since these can precipitate protein, worsening the clog.
If the clog resists simple flushing, unclogging can be achieved by:
(1) enzymatic digestion (papain and/or pancreatic enzymes mixed with sodium bicarbonate and water)
(1a) source of sodium bicarbonate, sufficient to raise the pH of final solution to 7.9 (needed to activate the enzymes): either crush a nonenteric-coated 324 mg table to a powder or use 0.125 teaspoon of baking soda
(1b) source of pancrealipase: either crush a pancrealipase tablet to a fine powder or use 0.25 teaspoon pancrealipase powder
(1c) Dissolve pancrelipase and sodium bicarbonate in 5 mL warm water.
(2) If a source of pancrealipase is not available, then a meat tenderizer may work.
(3) Use a specialized declogging device such as Clog Zapper (Corpak Medsystems).
If all of these steps fail, and if the line does not unclog on its own after a wait, then the tube will need to be withdrawn and a new line placed.
