From the Guidelines
For patients receiving continuous tube feeds, the typical water flush amount is 30 mL, and it is recommended to flush the tube before, between, and after each drug administration, as well as routinely to prevent tube obstruction. This recommendation is based on the strongest and most recent evidence from the ESPEN practical guideline on home enteral nutrition 1. The guideline emphasizes the importance of routine water flushing before and after feeding to prevent tube obstruction, which is a common complication in patients receiving home enteral nutrition (HEN) 1.
The use of at least 30 mL of water for irrigation when giving medicines or when flushing small diameter nasogastric tubes may reduce the number of tube occlusions 1. It is also essential to note that medicines should not be mixed before administration through an enteral feeding tube due to risks including drug-drug interactions, and that adequate flushing of the tube between feed and/or medications is necessary 1.
Key considerations for water flush regimens include:
- Adjusting the flush regimen based on the patient's fluid needs and clinical status
- Using room temperature water for flushing, with sterile water preferred in immunocompromised patients
- Regularly assessing the patient's hydration status and adjusting the flush regimen accordingly
- Being aware of the potential for tube occlusion and having strategies in place to address it, such as using a guide wire or commercially available tube declogger if necessary 1.
Overall, the goal of the water flush regimen is to maintain tube patency, prevent clogging, ensure proper medication delivery, and contribute to the patient's daily hydration requirements, while also minimizing the risk of complications associated with HEN.
From the Research
Typical Water Tube Feed Flush Amount and Frequency
- The typical water flush amount and frequency for patients receiving continuous tube feeds is not explicitly stated in terms of volume, but the frequency is mentioned as every 4 hours during continuous feedings 2.
- Flushing feeding tubes with water is a common practice to prevent tube obstruction, and it is recommended to flush the tubes every 4 hours during continuous feedings, after giving intermittent feedings, after giving medications, and after checking for gastric residuals 2.
- There is no specific mention of the volume of water to be used for flushing, but water is considered a cost-effective and readily available option for preventing tube clogging, comparable in efficacy to other agents like Coca-Cola 3.
Prevention of Tube Occlusion
- Tube occlusion is a common mechanical complication associated with enteral feeding, and prophylactic use of pancreatic enzymes or other agents has been studied as a means to prevent it 4, 5, 6.
- However, the efficacy of these agents in preventing tube occlusion is not consistently established, and water flushes remain a recommended practice for maintaining tube patency 2, 3.
Management of Tube Occlusion
- If tube obstruction occurs, attempts can be made to irrigate the tube with water or other agents like pancreatic enzymes or Coca-Cola 2, 6.
- The choice of agent and method for resolving an existing clog may depend on various factors, including the cause of the occlusion and the availability of agents 3.