Pepsi Flush for Nasogastric Tubes
Do not use Pepsi or other carbonated beverages to flush nasogastric tubes—sterile water is the recommended flushing agent, and if tube occlusion occurs, pancreatic enzymes (Viokase) are the most effective treatment. 1
Routine Flushing to Prevent Occlusion
- Sterile water is the standard flushing agent for maintaining nasogastric tube patency and preventing occlusion 1
- Tube occlusion occurs in 20-45% of cases, with rates increasing 10-fold when gastric residuals are checked through the feeding tube 1
- Carbonated beverages including Pepsi, Coke, Sprite, and Mountain Dew have been studied and proven inferior to water for tube maintenance 1
- Cranberry juice was also shown to be inferior to water for tube flushing 1
Managing Occluded Tubes
When a nasogastric tube becomes clogged despite proper maintenance, follow this algorithmic approach:
First-Line Intervention
- Simple water flushing successfully relieves obstruction in approximately one-third of occluded tubes 1
Second-Line Intervention
- If water flushing fails, pancreatic enzymes (Viokase in pH 7.9 solution) can reopen an additional 50% of occluded tubes 1
- In vitro studies demonstrated Viokase in pH 7.9 solution achieved the best dissolution of clotted enteral feeding (p < 0.01) 2
- When tested in occluded feeding tubes, Pepsi was successful in only 2 of 8 tubes, while Viokase in pH 7.9 solution successfully cleared 6 of 6 remaining tubes 2
- Clinical experience with Viokase solution injected through a Drum catheter showed success in 7 of 10 patients with occluded feeding tubes 2
Third-Line Intervention
- If enzymatic treatment fails, mechanical devices such as Fogarty balloon, biopsy brush, or commercially available tube decloggers should be attempted 1
Last Resort
- Tube replacement is performed only when all other methods have failed 1
Key Clinical Pitfalls
- Avoid using carbonated beverages based on outdated practices—controlled studies have definitively shown their inferiority 1, 2
- Smaller-diameter tubes (such as jejunostomy tubes) are particularly prone to clogging if not flushed properly 1
- Tube occlusion is often caused by interaction of protein-based formulas with acidic environments and medications 1
- Prophylactic use of pancreatic enzymes has demonstrated superiority in preventing tube occlusion 1