Using Pancrelipase to Unplug a Jejunostomy Tube
Pancrelipase can be used as a second-line agent to unplug a jejunostomy tube after warm water flushing fails, with evidence showing a 96% success rate for clearing formula-related clogs. 1
Initial Management Approach
Start with warm water flushing (40-60 ml) as the first-line intervention, which is particularly important for small-caliber tubes like jejunostomies and has been shown to clear most blockages effectively. 1, 2 Use gentle pressure to avoid damaging the tube, and never force the flush if you encounter significant resistance. 1
When to Use Pancrelipase
If warm water flushing fails to clear the obstruction, pancrelipase (pancreatic enzyme solution) is an appropriate second-line option with documented 96% efficacy for formula-related clogs. 1 The alkaline enzyme solution works by breaking down protein and fat deposits that commonly cause tube occlusions. 1
Important Caveats About Pancrelipase Use
- Recent FDA regulations have led to reformulation of pancreatic enzyme products, meaning older published protocols may not apply to currently available agents. 3
- Evidence for the efficacy of specific pancrelipase formulations in treating tube clogs has been limited and not consistently reproducible across studies. 3
- Well-designed in vivo trials are still needed to establish the proper dosing and formulation of pancreatic enzymes specifically for treating tube clogs. 3
Alternative Second-Line Options
If pancrelipase is unavailable or unsuccessful, a soft guidewire or commercially available tube declogger may be used by healthcare professionals with expertise in managing enteral tubes. 1, 2 However, this should be done carefully to avoid tube perforation. 1
Approaches to Avoid
- Do NOT use carbonated drinks (including cola) as they may cause tube degradation and increase bacterial contamination risk due to sugar content. 1, 2
- Avoid sodium bicarbonate solution as it lacks evidence-based support and should only be used with caution. 2
- Never rotate a jejunostomy tube when attempting to clear blockages, as this may damage or displace the tube; only push in and out. 1, 2
Prevention Strategies
The most effective approach is preventing clogs in the first place:
- Flush the tube with 40 ml of water before and after every feed or medication administration. 1, 2
- Use liquid medication formulations rather than syrups or crushed tablets when possible. 1
- Establish medication compatibility before administration, as hyperosmolar drugs and certain supplements are particularly likely to cause blockages. 1
- Push the tube in and out weekly (but do not rotate) to prevent complications. 2
When Replacement is Necessary
If all unclogging attempts fail, the tube will require professional replacement, which can be done via guidewire, endoscopy, or fluoroscopy with success rates exceeding 90%. 4 Jejunostomy tubes have an average longevity of only 3-6 months before replacement is typically needed. 4 The most common complications requiring replacement are mechanical failure (clogging, cracking, deterioration) and dislodgement, with clogging occurring in approximately 10.9% of cases in the early postoperative period and 8.2% in the late period. 5