Prophylactic Pancreatic Enzymes to Reduce Feeding Tube Occlusions

Background: Small-bore, feeding tube occlusion is reported to be as high as 23% to 35%. Pancreatic enzyme solution has been used to dissolve internal clots in feeding tubes. This study examined the prophylactic use of pancreatic enzyme solution with continuous enteral feeding in critically ill patients. Methods: This was a randomized, unblinded trial conducted in an intensive care unit at a tertiary care hospital. Feeding tubes were randomized to receive pancreatic enzyme solution every 4 hours or usual care. Pancreatic enzyme solution contained lipase 8,000 units, amylase 30,000 units, protease activity 30,000 units, sodium bicarbonate 300 mg, and 5 mL warm sterile water. Results: Ninety-five feeding tubes were followed up in 101 patients. Ten feeding tubes (9.9%) developed primary occlusions. Analysis revealed 2/52 (4%) of the tubes in the enzyme arm had occlusions, whereas 8/49 (16%) of control tubes had occlusions (p = .04). Time to occlusion was significantly longer in the pancreatic enzyme arm (p = .02). Conclusions: The use of prophylactic pancreatic enzymes may reduce the incidence of feeding tube occlusions.