Exploring the Cause and the Preventive Measures of Feeding Tube Occlusion during the Administration of ENSURE LIQUID^®

Abstract

To explore preventive measures for enteral feeding tube occlusion during the administration of enteral nutrition, we examined specific tube occlusion conditions by mixing enteral nutrient and highly versatile disease-specific nutritional supplements. We also examined whether tube occlusion could be prevented by stopping pH decrease through mixing enteral nutrient with sodium bicarbonate or other drugs that are alkaline in aqueous solution (magnesium oxide and fosfomycin). Mixing ornithine preparation (ORNUTE^®) with Ensure Liquid^® lowered pH and resulted in tube occlusion. At the same time, under the same conditions, the simple addition of suspended sodium bicarbonate kept the pH value within the dosage range specified on the package insert and avoided occlusion. Furthermore, when compared with the control cases, similar experiments using magnesium oxide or fosfomycin in the mixture were shown to prevent the pH decrease caused by ORNUTE^®. However, tube occlusion was unavoidable because of impurities and residue. This study demonstrates that a mixture including a disease-specific nutritional supplement with the potential to decrease pH is a risk factor for tube occlusion in enteral feeding administration. On the other hand, we consider drugs which produce no insoluble residue, such as sodium bicarbonate, to be suitable for addition to the ENSURE LIQUID^® prior to administration in order to prevent pH decrease.