Evaluation of the efficacy of management for occluded enteral access

Purpose: Occluded enteral access can compromise clinical outcomes by delaying enteral nutrition and medication administration. Immediate-release pancreatic enzymes mixed with sodium bicarbonate have demonstrated efficacy in restoring patency of feeding tubes. Due to the removal of these pancreatic enzyme formulations from the market in April 2010, a lack of evidence-based data exists for the management of occluded feeding tubes. The objective of this study is to compare the efficacy of enteric coated pancrealipase mixed with sodium bicarbonate and a declogging kit for management of occluded enteral access.

Methods: A retrospective, observational, single-center study was conducted evaluating occlusion events in patients 18 years or older, receiving tube feeding, and with an occluded feeding tube managed with enteric coated pancrealipase mixed with sodium bicarbonate and/or the declogging kit. The study was performed from January 2012-March 2012. Data collection consists of extracting information from the electronic medical record and an interview with nursing staff. The primary outcome for this study includes efficacy of restoring patency using enteric coated pancrealipase crushed and mixed with sodium bicarbonate and a declogging kit for managing occluded feeding tubes. Efficacy is identified per nursing report or chart review.

Results: A total of 76 occlusion events meeting inclusion criteria have been reviewed thus far. Patency was restored in 46.8% (n=47) in declogging kit treatment group and 44.8% (n=29) pancrealipase with sodium bicarbonate treatment group (p=0.91). A trend toward a higher rate of efficacy for nasoenteric tubes is present for the declogging kit compared to pancrealipase and sodium bicarbonate [pancrealipase 7/29 (38.8%) vs declogging kit 18/18 (50%), p= 0.44].

Conclusions: Delayed release, enteric coated pancrealipase crushed and mixed with sodium bicarbonate and a declogging kit are reasonable options for treatment of occluded enteral access. Analysis of additional patients is ongoing.