From the Guidelines
Treatment for sustain tube dysfunction should prioritize the use of percutaneous tubes instead of nasal tubes for long-term needs, as recommended by the ESPEN guideline on home enteral nutrition 1. This approach is based on the evidence that percutaneous tubes, such as PEG tubes, have a lower probability of intervention failure, including feeding interruption, blocking, or leakage of the tube, compared to nasogastric tube feeding 1. Key considerations for managing sustain tube dysfunction include:
- Routine water flushing after feedings to prevent tube occlusion, especially in small-caliber tubes like jejunostomies 1
- Using a guide wire or commercially available tube declogger by an expert in case of PEG tubes 1
- Elevating the head of the bed, post-pyloric feeding, and administration of motility agents to reduce aspiration in patients who are unable to protect their airways 1
- Managing gastrointestinal complications, such as constipation, diarrhea, vomits, and abdominal pain, which may be caused by the underlying disease, drug treatment, enteral formula, or administration method 1
- Monitoring for metabolic complications, including hyperglycemia, electrolytic disturbances, micronutrient deficiency, and refeeding syndrome 1
- Addressing stoma complications, such as excessive granulation tissue, leakage, peristomal infection, and the BBS, in patients with gastrostomy 1 In cases of tube defect, replacement should be accomplished in case of tube breakage, occlusion, dislodgement, or degradation, and can be performed endoscopically, radiologically, surgically, or at bedside, depending on the type of gastrostomy tube being replaced 1. Overall, the goal of treatment for sustain tube dysfunction is to reduce mechanical complications, prevent aspiration, and manage gastrointestinal, metabolic, and stoma complications to improve patient outcomes and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Sustain Tube Dysfunction Treatment
The treatment for sustain tube dysfunction is crucial to ensure the proper delivery of nutrition, hydration, and medications to patients. Some key points to consider:
- Enteral feeding tubes can be placed using various methods, including blind placement, fluoroscopic guidance, or endoscopic guidance 2.
- Complications related to feeding tube placement can be prevented by avoiding errors during the placement process and by early recognition and management of complications 2, 3.
- Clogged enteral feeding tubes can be cleared using various methods, including warm water flushes, enzyme treatments, and actuated mechanical occlusion clearing devices 4.
- Metoclopramide, a prokinetic agent, has been used to aid in the placement of naso-enteral feeding tubes, but its efficacy is controversial and it may include adverse reactions 5.
- Nasointestinal feeding has been shown to be effective in increasing the amount of feed tolerated in patients with delayed gastric emptying who have failed to respond to metoclopramide 6.
Treatment Options
Some treatment options for sustain tube dysfunction include:
- Using an actuated mechanical occlusion clearing device to clear clogged feeding tubes 4.
- Administering metoclopramide to aid in the placement of naso-enteral feeding tubes, although its efficacy is controversial 5.
- Using nasointestinal feeding as an alternative to nasogastric feeding plus prokinetic treatment in patients with delayed gastric emptying 6.
- Implementing protocols to prevent errors during feeding tube placement and to recognize and manage complications early 2, 3.