If there is a problem with flushing the tube, administering formula or medication, or a bulging tube with bolus feeding, the tube should be inspected for occlusions.

The clamp should be checked to make sure it is open. Beyond that, some causes include defective tubing, not flushing the tube appropriately, infusing at a very low rate, or the inappropriate administration of medications through the tube, which includes not adequately dissolving non-liquid medications, or failure to thoroughly flush the tube following medication administration. Some medications, such as Prevacid, may require special instructions.

In these cases, the first step is to assure that the clamp is open. Formula and medications should not be forced into a blocked tube. Attempts can be made to flush and reflush the tube with warm water using a large syringe. If this doesn’t work, the physician may prescribe the use of pancreatic enzymes (Viokase) to break up the clog. Note that the use of Viokase may not be appropriate for percutaneous endoscopic jejunally-placed tubes. Feeding rates and tube placement can also be discussed with the physician to prevent future problems.

In rare cases, a pump may fail. If the pump fails to start or has multiple alarms that don’t seem to have an obvious cause, then the pump should be stopped and connections checked to make sure that there is electricity available through the cord or battery. The patient and caregiver can go through the steps to troubleshoot according to the user manual. Any malfunctioning pump should be reported for replacement. Medical equipment supply companies are usually very quick to respond to mechanical failures. And until replacement occurs, feeding can be converted to a gravity drip at a lower rate.

•Tube obstruction/blockage: –Assure clamp is open –Do not force feeding or       medication –Try to flush tube –Notify physician for possible       replacement •Pump failure –Check connections –Troubleshoot with instructions –Report problem