Improving Patency of Feeding Tubes by Implementing a New Clinical Practice Guideline: A Quality Improvement Project

Background: Patients with feeding tubes are at risk of experiencing internal obstructions caused by clotting of intact protein formulas, crushed medications, refluxed gastric contents, and viscous products that enter the tube. A variety of anecdotal methods for attempting to unclog feeding tubes include flushing the tube with soda, cranberry juice, warm water, and using large-bore catheter flushes, which are not recommended for flushing through enteral feeding tubes because acidic solutions may coagulate proteins in enteral solutions and exacerbate clogging problems and large-bore catheters could disrupt the tube integrity (Kurish et al., 2021). Using previous studies and evidence-based research, a new clinical practice guideline using a Creon 12,000 unit capsule, a 650 mg sodium bicarbonate tablet, and 5 mL of sterile water was created to improve success rates for unclogging feeding tubes. Methods: A new clinical practice guideline to improve the patency of enteral feeding tubes was implemented at the University of Utah Health and Huntsman Hospitals. A Declog Kit with a Creon 12,000 unit capsule and a 650 mg sodium bicarbonate tablet was packaged in a vial, and the formulation was integrated into the electronic health record as an order-set for use by nursing staff. An educational PowerPoint was used to inform the enteral feeding tube nurses on the clinical practice guideline. Nursing documentation and survey data were evaluated for efficacy, feasibility, usability, and user satisfaction. Results: During this 60-day quality improvement project, a new clinical practice guideline using a Creon 12,000 unit capsule and a 650 mg sodium bicarbonate tablet (labeled as the Declog Kit), and 5 mL of sterile water was effective in clearing obstructions in 37 of 46 (80.4%) of clogged feeding tubes (when the regimen was added to current standard practices). The success rate was higher than the data collected during the pre-implementation period, which showed 38 of 69 (55.1%) efficacy in clearing occluded feeding tubes using standard practices. When assessing usability of the clinical practice guideline, <10% of feeding tube nurses allowed for a dwell time of one hour due to time constraints with competing high-volume consult needs. Conclusion: Despite the failure to follow the clinical practice guidelines due to time limitations as a barrier to consistent successful implementation, the results still showed improvement when using the clinical practice guideline in addition to standard practices for unclogging feeding tubes. Survey data additionally demonstrated a positive impact on user satisfaction. A more in- depth study is needed to validate the results are generalizable to the larger population and the efficacy for use of pancreatic enzymes and sodium bicarbonate to improve rates of unclogged feeding tubes versus the current standard therapies alone.