Water Flush Frequency for Bolus G-Tube Feeding
For patients receiving bolus gastrostomy tube feedings, water flushes should be administered with at least 30 mL of water before and after each feeding to prevent tube obstruction. 1
Recommended Flushing Protocol
For Bolus Feeding:
- Before each feeding: Flush with at least 30 mL of water
- After each feeding: Flush with at least 30 mL of water
- After medication administration: Additional flush required
Water Quality:
- Use fresh tap water, cooled boiled water, or sterile water 2
Rationale for Regular Flushing
Gastrostomy tubes are prone to blockages due to several factors:
- Chemistry of protein-rich enteral formulas
- Viscosity of nutritional formulas
- Small diameter of tube lumen 1
These issues are further exacerbated by:
- Longer feeding tubes
- Administration of medications through the tube
- Mucosal overgrowth around the tube 1
Special Considerations
For Continuous Feeding:
If a patient is transitioning between bolus and continuous feeding methods, note that continuous feeding requires flushing every 4 hours 1
Medication Administration:
- Always flush before and after medication administration
- Use liquid medications when possible instead of crushed tablets
- Avoid hyperosmolar drugs, crushed tablets, potassium supplements, iron supplements, and sucralfate as they increase risk of tube blockage 1, 2
Tube Maintenance Beyond Flushing
- Weekly maintenance: Loosen and rotate gastrostomy tube to prevent blockage through mucosal overgrowth 1, 2
- Positioning during feeding: Keep patient propped up at least 30° during feeding and for 30 minutes after to reduce aspiration risk 1, 2
Addressing Tube Blockage
If blockage occurs despite regular flushing:
- Attempt to irrigate with warm water
- If unsuccessful, try using an alkaline solution of pancreatic enzymes
- Avoid carbonated drinks, pineapple juice, and sodium bicarbonate solution as they may cause tube degradation 1
Patient Education
Routine water flushing should be included in patient and caregiver education as it is essential for preventing tube obstruction 1. This simple practice significantly reduces complications and extends the life of the feeding tube.
Remember that proper maintenance of tube patency is critical for ensuring consistent delivery of nutrition and medications, ultimately supporting better patient outcomes in terms of morbidity, mortality, and quality of life.