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17 AUG 2015 • 15-H1-044-0-00 • Folded size: 8”x10”
• Flush the feeding tube before and after medication administration and
between medications. This will prevent the medication from interacting
with formula and potentially causing the tube to clog.
• Use liquid medication when possible and consult the pharmacist to
determine if it is safe to crush solid medication and to mix with water. If
safe, pulverize the solid medication into a fine powder form and dissolve
the powder in warm water before administering through the feeding tube.
Never crush enteric-coated medication or mix medication with formula.
• Avoid using acidic irrigants such as cranberry juice and cola beverages to
flush feeding tubes as the acidic quality when combined with formula
proteins may actually contribute to tube clogging.
General Flushing Guidelines
• Use a 30 to 60 ml 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 Checklist
Assess the patient
Assess the patient for any signs of pain, pressure or discomfort, 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 jejunal, gastric and balloon ports
Use a cotton tip applicator or soft cloth to remove all residual
formula and medication.
Do not rotate the external bolster
This will cause the tube to kink and possibly lose position.
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 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.
• 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.
Kit Contents:
1 Low-Profile Gastric-Jejunal Feeding Tube
1 Introducer Cannula
1 6 ml Luer Slip Syringe
1 35 ml Catheter Tip Syringe
1 MIC-KEY* Continuous Feed Extension Set with SECUR-LOK* Right Angle
Connector and 2 Port “Y” and Clamp 12
1 MIC-KEY* Bolus Feed Extension Set with Cath Tip, SECUR-LOK* Straight
Connector and Clamp 12
4 Gauze Pads
Warning: For enteral nutrition and /or medication only.
For more information, please call 1-844-425-9273 in the United States,
or visit our web site at www.halyardhealth.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.
