Unclogging feeding tubes with pancreatic enzyme

Occlusion of small-bore feeding tubes (Dobbhoff, 8 French) was observed at our institution in 32 of 90 patients (35%) over an 8-month period. The purpose of this study was to evaluate possible causes of tube occlusion and to assess the efficacy of an activated pancreatic enzyme solution to clear obstructed feeding tubes. A Drum cartridge catheter was inserted into the occluded feeding tube to displace any liquid formula and to apply the enzyme solution close to the obstruction site. Water was injected first and served as control. The feeding tubes of 32 patients occluded 60 times during an 8-month period and declogging was attempted in 44 instances. Water was able to clear the obstruction in 12 cases. In the remaining 32 cases, the activated pancreatic enzyme was injected, and the obstruction was cleared in 23 cases (72%). The causes of failure to clear the obstruction were determined in seven cases: tablet impaction (three cases), knotted feeding tube (two cases), tomato seed occluded the feeding port (one case), formula clot in two-third length of the tube for 24-hr (one case). Thus, the pancreatic enzyme solution was successful in restoring tube patency in 23 of 24 instances (96%) where formula clotting was the likely cause of occlusion and Coke or water had failed.