Prophylactic locking of enteral feeding tubes with pancreatic enzymes

Abstract

Background: Obstruction of feeding tubes is a common mechanical complication associated with enteral feeding. Standard methods of flushing are not always effective. Methods: This study was conducted with patients receiving enteral feeding via nasogastric, nasoenteral, gastrostomy, or jejunostomy tubes to determine if prophylactic use of pancreatic enzymes would maintain patency of feeding tubes. Interrupted feeding regimens were used. Control patients (n = 24) received only water for flushing. After water flushing of the tube, study patients (n = 33) received a 5-mL suspension of pancreatic enzyme containing the following enzyme activity (in Federation Internationale Pharmaceutique [FIP] units): lipase, 2000; amylase, 1500; and protease, 100. The suspension also contained 90 mg of NaHCO3 to maintain a pH of 7.5. The mean duration of observation in the control and study groups was 25 and 48 days, respectively. Results: Compared with eight episodes (23.5%) of tube occlusions in the control group (n = 34), there was only one episode (2.6%) in the study group (n = 38). This difference was significant by the test of proportions (z = 2.68, p = .01). Conclusions: In addition to routine water flushing, the routine prophylactic use of pancreatic enzyme- sodium bicarbonate suspension (pH 7.5) prevents occlusion of feeding tubes.