الفهرس 
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Abstract
Enteral tube feeding, although a relatively safe method of nutritional support is associated with major and minor complications and many of which can be prevented or treated, one of them is enteral tube occlusion.
Tube occlusion or clogging is one of the most frequent complications of enteral nutrition. Feeding tubes can be occluded due to many reasons and the risk for occlusion varies with the type of the feeding tube, the tube tip location (gastric vs. small bowel), flushing agents and methods, formula composition, infusion rates, as well as techniques for making residual checks and enteral medications.
The impact of occluded enteral tube on a patient’s ability to receive adequate nutrition and hydration depends on the length of time it takes to resolve the clog or replace the feeding tube. Measures must be taken to prevent tube occlusion with declogging methods at hand to avoid delayed feeding and tube replacements. So the aim of current study to identify the effect of warm water flushing on the patency of occluded enteral tubes in critically ill patients.
Setting:
This study was conducted at Alexandria Main University Hospital (unit I, unit III).and Royal Hospital Intensive Care Unit.
Subject:
The sample of this study comprised of sixty adult critically ill patients of both sexes with newly inserted enteral access for feeding within 24 hours were included in the study. Data collection took approximately 8 months from (1/12/2014 to 1/8/2015).
To fulfill the aim of this study an enteral tube occlusion intervention and outcome tool was developed by the researcher comprising four parts:
The first part covered patient’s profile, diagnosis, past and present history.
The second part covered date of enteral tube insertion, duration of enteral feeding initiation, tube size, material, length and location, type of formula, enteral medication administration and fluid balance (intake, output).
The third part covered type, amount, consistency, frequency, temperature of formula and fluids allowed.
The fourth part included date and time, incidence of occlusion before, during, after (feeding, medication administration or after gastric residual check), type of flushing liquids (warm water or tap water), flushing volume, frequency of flushing, outcome of flushing (if enteral tube occlusion resolved or not).
Data collection:
All patients admitted to the previously mentioned ICUs and meeting the inclusion criteria were taken and divided randomly into 2 groups. For both groups, patient’s profile, tube related data, enteral tube’s medications and patient’s intake and output were assessed using part I and part II of the tool. For both groups, enteral tube formula related data and flushing checklist were collected by the researcher using part III of the tool.
For control group, the patients observed for four consecutive days until enteral tube occlusion occurred and any interventions performed to unclog the enteral tube by critical care nurses were observed and documented by researcher using Part V of the tool. For study group, intervention for declogging enteral tube done by researcher using warm water. The outcomes of implemented interventions for occluded tube for both groups were monitored and recorded using part V of the tool and it include resolved and unresolved enteral tube occlusion.
Results:
The result of the current study revealed that the most common age for patients in study and control groups was more than 45 years (66.7% of the patients in the study group and 56.7% of the patient in the control group), the male patients represent more than half of both control and study groups (60% of the patients in the study group and 53.3% of patients in the control group). Also 43.3% of patients suffered from neurological disorders in study group while 33.3% of patients suffered from cardiovascular disorders in control group. And from 13% to 20% of patients suffered from other disorders.
It was observed that the highest rate of enteral tube occlusion occurred during feeding (50.0% of control group and 36.7% of study group).
The current study revealed that 93.3% of enteral tube occlusion resolved in the study group after using warm water while 66.7% of enteral tube occlusion resolved in control group which using tape water and statistically significant .
It was observed that tube flushing was not done before feeding in the control and study groups (100%) while flushing after feeding was done in the majority of both groups (93.3% in control group and 96.7% in study group). Flushing was done between medications administration in the majority of control and study groups (75.9% of control group and 93.3% of study group), Also it was observed that flushing after medication administration was done in the majority of control and study groups (86.2% of control group and 90% of study group).
It was noted that flushing was not done after gastric residual check in the majority of both groups (96.7% in control and study groups) and there were no significant differences between both groups.
It can be concluded that the effect of warm water in resolving enteral tube occlusion better than tap water and there were significant differences between control and study groups.
Recommendations
Warm water should be used to unclog the occluded enteral feeding tube. The development of and adherence to feeding, flushing, and medication administration protocols can significantly reduce the occurrence of enteral tube occlusions. In addition, the development of gastric residual checking policies in coordination with nursing and nutrition departments may be beneficial as well.