Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
2. 2.Show
   Always flush the enteral tube before and after administration of feed and medication with at least 30 mL of water (sterile water for jejunostomy and for immunosuppressed patients).
   To avoid the tube blocking. Sterile water should be used for jejunostomy tubes as the water is bypassing the protective acidic environment of the stomach. E
3. 3.Show
   Examine the tube for kinks.
   To ensure that this is not the cause of the blockage (BAPEN [11], E).

Procedure

1. 4.Show
   Draw up 30 mL of water (lukewarm) in a 60 mL ENFit enteral syringe and attempt to flush/withdraw fluid from the tube. Boiling or hot water must not be used to flush an enteral feeding tube.
   To dissolve any medication or soften any feed plugs in the tube. To prevent hot water being administered via the feeding tube (BAPEN [11], C).

   To remove blockage and acidic fluids such as carbonated drinks that may cause feed to clot (BAPEN [11], C).
2. 5.Show
   If the tube is still blocked, consider use of a proprietary product designed to unblock tubes. Follow the manufacturer's instructions.
   To break down the plug. Such products contain digestive enzymes, which may break down a protein plug, but they may not unblock a tube blocked with medication (manufacturer's recommendation, C).
3. 6.Show
   If all of the above are unsuccessful then the enteral tube will need to be replaced.
   To ensure continued enteral access for the administration of feed, fluids and medication. E

Post‐procedure

1. 7.Show
   Document the procedure in the patient's notes.
   To record actions and outcome (NMC [126], C).