Portal de Periódicos da CAPES

A simple method for clearing obstructed enteral feeding tubes

1986; Elsevier BV; Volume: 32; Issue: 1 Linguagem: Inglês

10.1016/s0016-5107(86)71737-9

1097-6779

Antonio Caos, Howard K. Gogel,

Child Nutrition and Feeding Issues

A simple method for clearing obstructed enteral feeding tubesTo the Editor:Since the development of small, flexible feeding tubes,I enteral nutritional support is increasingly recognized as a safe and effective therapeutic option in certain patients suffering from malnutrition. 2 -4 This form of therapy is particularly useful in patients with benign or malignant strictures provided tube placement beyond the obstruction is performed with fluoroscopic or endoscopic guidance. 5,6 Unfortunately, tube obstruction can sometimes occur with prolonged therapy.7 Early obstruction is usually due to pump malfunction, high formula viscosity, or failure to irrigate the tube when using intermittent administration.Ordinarily, if irrigation fails to clear the tube in these patients, fluoroscopy or endoscopy would have to be re-employed for tube replacement.A simple, alternative method of clearing the obstruction would be welcomed by both the cost-conscious physician and the anxious patient.Recently, tube obstruction occurred in one of our patients with a malignant esophageal stricture after several days of enteral feeding via an endoscopically placed Dobbhoff enteric feeding tube (8 FR/I09 em).After checking adequate tube position by abdominal plain film, we were able to clear the obstructed tube by passing a new standard cytology brush (Olympus BC-IJ) down the tube's lumen.We measured out 105 em and marked our brush accordingly to avoid passing the brush through the side holes.After a drop of silicone was applied to the brush, it was slowly passed to the measured length and then slowly pulled out without incident.Afterward, the patency of the tube was documented by injecting saline.The position of tube tip was checked by abdominal x-ray, and enteral alimentation was restarted.To further assess the safety of this technique, we tested several feeding tubes in vitro; Dobbhoff (8 F/109 em), Vivonex tungsten tip (8 F/114 em), and the silicone elastometer Duo-Tube (8 F/I02 em).We failed in multiple attempts to perforate their lumens with the cytology brush under several conditions using manual force: with the tube straight; with multiple loops; with extreme, fixed angles; at room temperature; and at 55•C.Thus, the likelihood of perforation of these feeding tubes with the cytology brush is negligible.The side ports of the Dobbhoff brand tube are large enough to allow the brush to go through; thus, premeasurement of brush insertion length is necessary.We have had the opportunity to repeat this technique on several occasions with the above mentioned feeding tubes and have found it technically simple and safe with excellent patient tolerance.Manufacturers' recommendations for periodic tube replacement to avoid severenee is not obviated by this technique.We conclude that this technique is an effective, safe, and less costly alternative method for dealing with obstructed feeding tubes in patients in whom replacement is technically difficult and potentially hazardous.