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Repassing Fine Bore Feeding Tubes

 

All Corflo Fine Bore Feeding Tubes manufactured by Viasys Medsystems and distributed in the UK and Republic of Ireland by Merck Gastroenterology are labelled as single patient use devices. This means that the tubes can be re-passed on the same patient provided that the tube to be re-passed has maintained its functionality and integrity.

In between use it is recommended that the Corflo Fine Bore Feeding Tubes are cleaned inside and out with household detergent (washing up liquid) in water no warmer than hand warm. The tubes should then be rinsed inside and out and hung up to air dry prior to storage. Do not use hot water, the tube may shrink.

The tubes are only sterile prior to the first use of the product. The tubes are not suitable for re-sterilisation.

By using these guidelines there is no prescribed life expectancy and, as stated, the decision to replace a Corflo nasogastric tube should be made on the basis of clinical judgement or as per any relevant hospital protocol.

It is advised however that the Corflo nasogastric tubes should be swapped between nostrils every 4-6 weeks to avoid nasal degradation.

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Confirmation Of Tube Placement

 

The correct position of the tube in the stomach is essential for the well-being of the patient. The use of auscultation and litmus paper is not recommended by NICE or Merck Pharmaceuticals. Aspiration of the stomach contents using a pH indicator is frequently recommended to confirm nasogastric placement. These indicator strips need to have a range that can detect stomach pH and be measurable in 0.5 increments.

The most reliable method of checking the correct position of the tube is by radiography. However, this method is often avoided because of:

  • Risk to the patient of frequent exposure to x-ray
  • Potential delay in administration of nutrition
  • Cost and resource implications.

An alternative to pH and radiography is the Cortrak Enteral placement system. Of these methods, pH Indicator Strips are the most commonly used way of confirming placement. Individual circumstances will dictate which method is more appropriate.

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Corflo Enteral Feeding Tube - Pressure When Using Syringes

 

Viasys Medsystems conducted a study to determine the pressure inside Viasys Medsystems feeding tubes using different syringes at varying force and their effect on the strength of Viasys Medsystems Feeding Tubes 2.

Three tests were done on five different size tubes; 5 Fr., 6Fr., 8 Fr., 10 Fr., and 12 Fr., using 6 different syringes; 3ml, 6ml, 10ml, 20ml, 30ml, 50/60ml. In the first test the syringe injected water and the tine was checked for bursts. In the second test the syringe evacuated air and the tubes checked for collapse. The third test involved evacuating air from the tubes. In each test the tubes were occluded 3 inches from the top to simulate a clogged tube.

The result of the first test was that none of the tubes burst. Each tube withstood an internal pressure of 80psi or higher with one or more syringes. Pressures of up to 100 psi were recorded. The first test provided evidence of the known fact that smaller syringes produce greater pressures using less force than larger syringes. However, smaller syringes are of less volume, so a 3ml syringe would be very unlikely to burst a tube. Larger syringes could burst a tube, but the force required would be tremendous.

Whilst performing the test, it was noted that the syringe most at risk for bursting the tubes is the 6ml model, which produced 100psi at 19.4 lbs force on the plunger. It is unlikely that a user could provide this amount of force.

The second test showed a general trend that the smaller syringes can create higher negative pressure at lesser forces than the large syringes.

The third test involved evacuating air from the tubes. The forces required to evacuate air from the tubes were small enough that a person, with some effort, could pull the plungers out of each syringe. A bigger syringe would be more likely to collapse the tube than a small one. As the second test confirmed, however, the tubes did not collapse when the syringe plungers were pulled to their full position.

It therefore seems unlikely that, in normal clinical use, the feeding tubes would burst or collapse because typically a person would not be able to exert enough force on any syringe to burst them. If the tube was clogged, a user pushing or pulling with force would realise that there is an obstruction and stop before the tube burst or collapsed.

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Can Fine Bore Feeding Tubes Be Frozen And Then Inserted Into The Patient Rather Than Having A Stylet Within The Tube?

 

There is no evidence that freezing will improve tube passage. PVC and silicone stiffens when frozen but polyurethane does not. The Corflo Fine Bore Feeding Tubes are all made from polyurethane. We have no data on the effect of freezing a tube and our advice is to store them at room temperature.

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'Shrinking' Fine Bore Feeding Tubes

 

Sometimes health professionals complain that the fine bore feeding tube has 'shrunk' and the stylet is protruding out the top. The reason for this is that the tube has been cleaned with hot water, which will cause the tube to shrink. Hand warm water should be used and the tubes are not suitable for re-sterilisation or cleaning with hot water.

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Paediatric Use Of Corflo Enteral Feeding Tubes

 

The enteral feeding tubes are CE certified for use in all patient groups, ie there is no differentiation between adult and paediatric use.

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Corflo Percutaneous Endoscopic Gastrostomy (PEG) Placement And The Commencement Of Feeding

 

Our post insertion care guidelines recommend commencing feeding 6-12 hours after PEG placement, starting with water only. These guidelines are based upon common medical practice in the UK as recommended by many of our customers.

There is a risk of trapping the transverse colon during the placement procedure of a PEG and it has therefore been recommended to wait a few hours prior to feeding to allow the bowel to re-position itself if this has occurred.

As the patient may have been starved 6-12 hours pre surgery and 6-12 hours post surgery, it’s recommended that the patient is initially given water before enteral nutrition is introduced.

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Flushing Enteral Feeding Tubes Not In Use: Peg And Cubby

 

If a patient has a PEG tube fitted, but isn't in use (either medication or feed) it still has to be flushed on a daily basis with 30mls of water. This is to prevent clogging from the other end of the PEG (from contents in the stomach).

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Sea Water And The G-Tube

 

There is no immediate danger that sea water will cause damage to a G tube, but this may depend on the concentration of salt in the water and how often the patient is swimming in it. The balloon in the G tube may fail sooner than normally expected due to the concentration of salt in the water.

Care for the stoma site as normal and clean site immediately after a swim.

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Latex Content Of Corflo Enteral Feeding Products

 

We can categorically state that all Viasys Medsystems Corflo enteral feeding products are totally free from latex. The enteral feeding tubes and PEG tubes are manufactured from Polyurethane and the Replacement Gastrostomy Tubes and the Corflo-CuBBy are manufactured from silicone. Furthermore, Viasys Medsystems do not construct any products from latex, so no Viasys Medsystems feeding products can come into contact with latex products during their manufacture.

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Can The Viasys Medystems Devices Be Used In MRIs?

 

Viasys Medsystems have provided this statement with regard to all Corflo branded products: generally speaking as there are many different pieces of MRI equipment and Viasys Medsystems are not specialists in this field, they would advise the customer to contact the manufacturer of the machine for specific confirmation.

The Tungsten weighted tips found on a few of our tubes can cause artefacts to appear on the screen if the weight is positioned close to the part being examined. The tungsten tips are non ferrous and so are not magnetic but for detailed advice the customers should contact the manufacturer of the MRI machine.

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Air Pressure (Flying) And Devices

 

Patients with PEG and Gastrostomy tubes should not be concerned about commercial flying. There is no evidence that the change in pressure associated with flying has any effect on either the water filled balloon or the internal bolster of the PEG tube.

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Sizes Of The Lumens Of The Viasys Medsystems Devices

Viasys Medsystems Low Profile “Cubby” French size Ref. Diam (in)
  12 0.087
  14 0.103
  16 0.130
  18 0.146
  20 0.167
  22 0.198
  24 0.224
     
Viasys Medsystems IF g-tube
(bi-funnel)		 French size Ref. Diam (in)
  12 0.0185
  14 0.105
  16 0.120
  18 0.137
  20 0.157
  22 0.168
  24 0.190
     
Fine bore feeding tubes Mm ID Mm OD
5 1.10 1.65
6 1.37 2.18
8 1.96 2.87
10 2.54 3.56
12 2.67 .06

 

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Unblocking Feeding Tubes

 

When using Clog Zapper, you only need to fill the enteral feeding tube from the clog as far as the Y-adapter. Depending on the French size of the tube, the amount varies. If you do not use the entire 10cc volume of Clog Zapper, you can refrigerate the remainder for use within 24 hours.

It’s a clinical decision whether the ingredients or quantities are suitable for the patient, and hence also if repeated administration is appropriate. If the tube keeps blocking, it may be worth considering changing the tube.

We advise that fizzy drinks should not be used as they may shorten the life span of the tube, cause abrasion within it and may clog the tube with sugar. Fizzy drinks may be useful in unblocking tubes, but as they may also affect their functionality, they should only be considered when all other appropriate methods have been tried. If using a fizzy drink to unblock a tube, the most appropriate option is carbonated water, due to its low sugar content.

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Repeated Clog Zapper Administration

 

The instructions for the use of Clog Zapper state that the health care professional can repeat steps 4 to 8 if a tube still cannot be flushed after attempting to unclog it. This means that you can repeatedly administer Clog Zapper to the patient

Clog Zapper does not contain any medication, it is a food-grade powder combining enzymes, acids, buffers, anti-bacterial agents and metal inhibitors.

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Do The Viasys Medystems Devices Contain DEHP?

 

Polyvinyl Chloride (PVC) is a plastic polymer that is used in a wide array of products. Unplasticised PVC is hard and brittle at room temperature. A plasticiser (softener) is typically added to increase the flexibility of the polymer. DEHP is the plasticiser for most PVC medical devices. The products which VIASYS MedSystems manufacture from PVC for sale in the UK through our business partner Merck Pharmaceuticals are:

090120037 Gastrostomy Y extension set
090120342 Corflo-cuBBy Bolus Feeding set,
090120343, 090120344, 090120345 Corflo-cuBBy Right Angle Feeding sets 8cm, 30cm and 60cm lengths 5.

Everyone is exposed to small levels of DEHP in everyday life. However, some individuals can be exposed to high levels of DEHP through certain medical procedures. DEHP can leach out of plastic medical devices into solutions that come in contact with the plastic.

Two factors determine the degree of risk posed by exposure to DEHP in a medical setting. The first is the patient's sensitivity to DEHP and based on the evidence from the FDA (US food and Drugs Administration), the male foetus, male neonate, and peripubertal male are designated as high-risk groups. The second factor is the dose of DEHP received by the patient and this is determined largely by the type of procedure performed, as well as the frequency and duration of these. Although Enteral nutrition is cited by the FDA as a High risk procedure this refers to the whole feeding process. When considering the length of time that the feed is in contact with the extension sets supplied by VIASYS MedSystems the exposure risk attributed just to the use of these sets in isolation is very low.

Of greater significance would be the type of container used to store the feed and the type of NG tube used to deliver the feed as these specific aspects of the Enteral feeding process have been identified as potential areas of risk in high risk areas such as Neonatology. Furthermore VIASYS MedSystems do not supply any PVC based Nasogastric feeding tubes to Merck Phramaceuticals.

Advice from the FDA states that people should “not avoid the procedures cited simply because of the possibility of health risks associated with DEHP exposure. The risk of not doing a needed procedure is far greater than the risk associated with exposure to DEHP” Therefore the risks are reportedly quite small.

This leaves us to believe that currently our products are more reliable and longer lasting due to the inclusion of a DEHP softener. No plans exist to change the softener used at the moment.

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References:

 

1. Post insertion care of the Corflo PEG, ZZ03132, Merck Pharmaceuticals, February 2004

2. Viasys Medsystem; Effect of syringe pressure on Viasys Medsystems feeding tubes, Protocol # 170, August 17, 2000.

3. Instructions for use of Clog Zapper, Viasys Medsystems, 1996.

4. Latex Statement, Viasys Medsystems, September 2004.

5. Use of Phylate softeners in PVC feeding sets, Viasys Medsystems.

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