Virtual Hospital: Rx Update: Declogging Feeding Tubes with Pancreatic Enzymes

Rx Update: November 2000

Declogging Feeding Tubes with Pancreatic Enzymes

Mary Ross, R.Ph., M.B.A.
Peer Review Status: Internally Reviewed

Until recently, Pharmacy and Nursing policies differed in their guidelines for using pancrelipase (Viokase®) and sodium bicarbonate (NaHCO3) to unclog feeding tubes. Now, a method has been developed to standardize the procedure for unclogging feeding tubes at UIHC to help avoid the confusion with different recommendations, to ensure they are administered correctly, to avoid delays in obtaining necessary supplies, and to reduce preparation time.

There are a limited number of published clinical trials studying the appropriate dose of pancrelipase (Viokase®) for unclogging feeding tubes. The main study that is published by Marcuard1 used one pancrelipase (Viokase®) tablet with a 324 mg sodium bicarbonate tablet mixed in 5 ml water. They had an overall success rate of 72% (23/32) for unclogging feeding tubes due to all causes of clogs. When just the clogs that were due to feedings were evaluated, they had a success rate for unclogging the feeding tubes of 96% (23/24). Most "review" articles reference this study and its method of administration.

The new UIHC recommendations will use one 650 mg sodium bicarbonate tablet and 2 pancrelipase (Viokase®) tablets, crushed and mixed in 5 to 15 ml of lukewarm water. This will provide for a final concentration of lipase 16,000 units, amylase 60,000 units, protease 60,000 units, and sodium bicarbonate 650 mg, the approximate ratio that Marcuard1 used. As previously noted, these concentrations have documented efficacy and are frequently referenced in the literature. Pharmacy will prepare single-dose 'kits' that contain two pancrelipase (Viokase®) tablets and one 650 mg sodium bicarbonate tablet in a zip-lock bag with directions for use (see below). These kits are available as floorstock or from the decentralized pharmacy satellite serving your area.

Directions for Using The Kit to Unclog Feeding Tubes

Crush two pancrelipase (Viokase®) and one sodium bicarbonate tablets to a fine powder.
Mix both powders together well.
Add 5 to 15 ml of warm water to the powder mixture and stir well.
Draw up mixture in 20 ml syringe.
Attach syringe to the end of the clogged feeding tube.
Instill the slurry into the feeding tube using gentle pressure. If unable to instill mixture, try inserting a small feeding tube (e.g., 5F into 8F tube) as far as it will go and instill the mixture through it to place slurry as close to the clog as possible.
Clamp the tube for 15 to 30 minutes.
Flush the tube gently with 20 ml of warm water.
If unable to flush/unclog the tube, may repeat with a new kit. Notify physician if unable to unclog the tube after 3 attempts.

Refer also to the Nursing Policy: "Declogging Feeding Tubes with Pancreatic Enzyme (Viokase®)."

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