What is the management of a suspected block in a nasogastric (NG) tube during continuous feeding?

Management of Suspected Blocked NG Tube During Continuous Feeding

When a nasogastric (NG) tube blockage is suspected during continuous feeding, the first step should be to flush the tube with 30-50 mL of warm water using a syringe to attempt to clear the obstruction. 1

Initial Assessment

When a blocked NG tube is suspected:

1. Stop the feeding immediately
2. Verify tube placement before attempting to clear the blockage:
   • Check pH of aspirate (should be acidic)
   • Observe for signs of tube displacement

Clearing Protocol for Blocked NG Tubes

First-Line Approach:

• Flush with 30-50 mL of warm water using a gentle push-pull technique with a syringe
• Never use excessive force as this could rupture the tube or cause displacement

If Initial Flush Fails:

• Try flushing with carbonated beverages (such as cola) which may help dissolve protein or medication residues 2
• Use a gentle push-pull motion with the syringe to create turbulence in the tube

For Persistent Blockages:

• Consider pancreatic enzymes mixed with sodium bicarbonate solution if available (consult pharmacy)
• Allow solution to dwell in the tube for 15-30 minutes before attempting to flush again

Prevention of Future Blockages

1. Regular Preventive Flushing:

   • Flush NG tubes with 20-30 mL of water every 4 hours during continuous feeding 2
   • Always flush before and after medication administration
   • Flush after checking gastric residuals

2. Medication Administration:

   • Use liquid medications whenever possible
   • Crush tablets completely and dissolve thoroughly
   • Administer medications separately from feeds with water flushes before and after 1

3. Formula Considerations:

   • Ensure formula is appropriate viscosity for tube diameter
   • Use feeding pumps for continuous administration to maintain consistent flow 1

When to Replace the Tube

If blockage cannot be resolved after multiple attempts:

• The tube should be removed and replaced 1
• Document the incident and the interventions attempted
• Consider using a larger diameter tube if appropriate for the patient

Special Considerations

• Patients receiving continuous feeding are at higher risk for tube blockage due to formula residue buildup
• Fine bore tubes (5-8 French) are more prone to blockage than larger tubes 1
• Proper tube securement is essential to prevent displacement during clearing attempts 3

By following this systematic approach to managing suspected NG tube blockages, you can minimize complications and maintain adequate nutritional support for patients requiring enteral feeding.