Policy Manual sample

MDT Home Health Care Agency, Inc. 38 ENTERAL TUBES - UNCLOGGING PURPOSE: Registered Nurses who have successfully completed the required credentialing may irrigate enteral feeding tubes to reestablish patency. The nurse should assess the relative risks of unclogging and discuss with physician as needed. RESPONSIBLE PERSONNEL : RN/ LPN with documented credentialing. EQUIPMENT: *Syringes (30 ml to 60 ml) with compatible or catheter tip. *Warm water *Carbonated beverage *Acidic juice *Meat tenderizer (optional, if patient demonstrates no allergy) *Non-sterile gloves GENERAL CONSIDERATIONS: 1. The optimal approach to maintain patency of enteral feeding tubes is to follow procedures for administration of feeding and medications. Obstruction may be anticipated as a common problem when: • Small feeding tubes are used (#10 French or smaller). For this reason, MDT Home Health Care Agency, Inc. recommends that nurses consult with the physician regarding placing a # 12 French or larger whenever possible on adult patients. • Viscous formulas are delivered as a slow rate • Gastric retention causes stasis of gastric contents • Non-liquid medication or supplements are administered • Fluid administration is restricted • Gastric content includes the residue of oral feeding. 2. Attempts to unclog enteral tubes carry risks of tube displacement, tube rupture and patient injury. In an effort to minimize the risks: • Assess the patient's recent history of tube-related complications and their resolution • Use the most conservative approaches first • Consult the physician for discussion of options available in unclogging the tube 3. Discuss the physician modifications in care that minimize the recurrence of clogging: • Choice of feeding formula or delivery method • Alternate choice of tube • Form of, or substitute for, medication • Frequency, amount and type of tube flush