Tube feeding is a way to deliver to patients the nutrition that their body needs when normal eating is compromised. Tube feeding (aka enteral feeding) delivers nutrition and medication to the body through a flexible tube. The nutrients within the feeding tube are similar to what someone would get from a normal feeding and digested the same way, usually in the stomach. Tube feed contains all the nutrients one needs on a daily basis, including carbohydrates, fats, protein, vitamins, minerals, and water. Medication is also often administered through a feeding tube. Everyone has different nutritional requirements, and will depend on a number of factors, including patient’s height, activity level, weight, medical condition, home circumstances, and whether there is capability to eat or drink. People may need a feeding tube in quite a few health situations that may leave them with the inability to safely swallow food and water. There are also other delivery locations for a feeding tube besides in the stomach. Some feeding tube sets allow for suctioning out air and stomach contents when needed.
If a patient has a feeding tube or cannot swallow medication, medication has to be crushed and dissolved in liquid to administer through a feeding tube. About 40% of all medications are available only in liquid form so there are many that have to be prepared for feeding tubes. When crushing medication, it’s important for medical practitioners to perform this process correctly so the correct dose is administered and the pills mix in properly with the fluid so the feeding equipment doesn’t get clogged. Here are the steps for how to crush medication for tube feeding:
- Perform Hand Hygiene and Gather Necessary Supplies - For tube feeding, an enteral syringe, (ENFit) of the appropriate size is needed. Some patients are liquid sensitive so choose the appropriate size of syringe to accommodate the patient. A Pill crusher, medication pouch, gloves, medication, and room temperature water is needed depending on how many pills are to be crushed. The hospital should have protocols for flushing the feeding sets. Some patients can receive medications orally after mixing into apple sauce, pudding, or other soft foods. Pill crushers, spoons, pill pouches, gloves, and medication are needed to prepare the meds before mixing into food.
- Administration Rights - The medical practitioner will confirm the patient’s 5 medication administration rights: right patient, right dose, right time, right route, and the right medication.
- Medication Confirmation - Before medications can be crushed, determine if the medications can be crushed. Not all pills can be crushed. It’s important to consult with pharmacists to verify if a medication can be crushed. Always look at the name of the drug for certain letters. For example, Toprol XL and Detrol LA are both long-acting medications that cannot be crushed because it will destroy timed release intentions. General categories of drugs that cannot be crushed include Enteric Coated (EC), Long-Acting (LA, XL), Extended Release (ER, XR), Controlled Release/Delivery (CR, CD), and Sustained-Release/Action (SR, SA).
- Handling Multiple Medications - Many medications are not compatible after you crush the protective coating surrounding the material. Active chemicals of the pills can decrease the effectiveness of the medication so must be crushed separately.
- PPE - Gloves must be worn to protect from contamination from the medication’s powder, for cleanliness and protection against toxicity. Depending on the toxic level of drugs, gowns, masks, head coverings may also be required.
- Crush Pill - Place the pill in a pill crushing pouch. Always use a device that is made to crush pills. Avoid crushing multiple medications together although multiple pills of the same medication can be manipulated. Pill crushers are generally easy to clean and allow for crushing multiple pills. Become familiar with how to use the facilities’ devices. In addition, when administering crushed medication through a feeding tube. Always follow your hospital’s protocol for crushing medication.
- Tube Feeding - After crushing, dissolve the finely crushed powder of the pill in the optimum amount of room temperature water or solution. This works best if you mix the crushed medication in a pill pouch that seals. If not available, use a mixing cup that will hold the appropriate amount of liquid to dissolve medication. Use an ENFit enteral syringe to draw up the medication. Make sure to follow your hospital’s protocol for flushing before, during, and after the administration of medication.
Clogged feeding tubes can cause significant trouble when delivering dissolved medication to enteral feeding tubes. Clogged tubes increase the time and costs for health care providers and to patients if they must be replaced. Misinformation abounds on the internet and among health care providers on how to prevent and safely address clogged tubes. Evidence-based guidelines for clinicians for feeding tube clog prevention and declogging must be followed. Enteral feeding tubes are a lifeline for those patients who rely on them every day for nutrition, hydration, and medication administration. The cost of supplies, nursing care, and confirmatory abdominal x-rays required for simple tube replacement is significant when multiplied across a large scale. If you notice resistance when you try to take water, formula, or medication through your feeding tube, the tube may be clogged. Here are some tips to follow to solve this problem.
- First, check if the tube is clamped or kinked anywhere which may cause medication to be blocked. Feeding tubes can also be clogged due to dried formula or medication that sticks to the side of the tube.
- Second, you may be able to clear the tube yourself using warm water and an appropriately sized ENFit syringe. Water is the best choice to unclog your tube, as other fluids are ineffective and can worsen the clog. To unclog the tube, follow these steps:
- Always wash your hands before handling the feeding tube and supplies.
- Attach an ENFit syringe to your tube and pull back on the plunger to remove as much fluid as possible.
- Draw up to at least 15 mL of warm water into the syringe, or enough to fill the part of the tube that you can see.
- Push the water into the tube from the ENFit syringe. Gently push and pull the plunger to loosen the clog.
- If the clog doesn’t release right away, clamp the tube and let the water soak for about 15 minutes. You may also try gently massaging the tubing with your fingertips.
- Unclamp the tube and repeat steps 1 through 5. If you cannot clear the clog or if you are still unable to use your feeding tube, it’s best to contact a nurse or doctor.
- It’s always best to prevent a clogged feeding tube. To do this, you have to:
- Flush the tube on a regular basis with the amount of water needed. Always flush the tube before and after you use it to take formula or medications.
- It’s more common for medication to clog the tube so be sure to dissolve medication properly and flush your tube afterward.
- Flush the tube every few hours or so and keep the tube closed when you are not using it.
- Use enteral cleaning kits to keep feeding sets clear of dried medication.