# Situation: A 66-year-old man had a partial glossectomy and neck dissection for oral cancer. He receives continuous formula through a small-bore nasogastric (NG) tube whose position was confirmed by radiograph (X-ray) after insertion; the tube's mark reads 60 cm at the nostril. On day 7 the tube will not flush. Which action is BEST to try first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630474  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 66-year-old man had a partial glossectomy and neck dissection for oral cancer. He receives continuous formula through a small-bore nasogastric (NG) tube whose position was confirmed by radiograph (X-ray) after insertion; the tube's mark reads 60 cm at the nostril.

On day 7 the tube will not flush. Which action is BEST to try first?

## 보기

1. Flush with room-temperature water using a 10-mL syringe
2. Instill cola, clamp the tube, and wait 30 minutes
3. Flush with warm water using gentle push-pull **✔ 정답**
4. Reinsert the guidewire to clear the blocked lumen

**정답: 3**

## 해설

Warm water with gentle push-pull movements is the first-line method for a blocked feeding tube, followed by an enzyme declogger per policy. Cola or cranberry juice is used only if policy allows, reinserting the stylet can perforate the tube and esophagus, and small syringes generate high pressure that can rupture the tube.

## 심화 해설

First-line method for a blocked tube
On day 7 the feeding tube will not flush, most often because formula or crushed medication has clotted in the lumen. Warm water with gentle push-pull movements is the first-line method for a blocked feeding tube, followed by an enzyme declogger per policy. Warm water helps dissolve the clot, and alternating gentle pushing and pulling on the plunger loosens it without generating dangerous pressure.

Why the syringe size matters
Pressure inside a syringe is inversely related to its barrel size: a small syringe generates much higher pressure for the same force. Using a 10-mL syringe on a blocked small-bore tube can rupture the tube. A larger syringe, typically 30–60 mL, is used for flushing and unclogging. Room-temperature water is also less effective than warm water at dissolving a formula clot.

| Option | Problem | Verdict |
| --- | --- | --- |
| Room-temperature water, 10-mL syringe | High pressure can rupture the tube; less effective | Wrong |
| Cola, clamp 30 minutes | Not first-line; acidity can make formula clump | Only if policy allows |
| Warm water, gentle push-pull | Safe and effective first step | Correct |
| Reinsert the guidewire | Can perforate the tube and injure the esophagus | Never |

Why the other methods are not first
Cola or cranberry juice has been used to dissolve clogs, but it is not first-line and is used only if policy allows; its acidity can actually cause formula proteins to clump. Reinserting the guidewire, or stylet, into a tube that is in the body can pierce the tube wall and injure the esophagus or stomach, so it is never done. If warm water fails, the next step is an enzyme declogger according to policy, and if the tube remains blocked it is replaced.

Watch out! Small syringes feel easier to control, which makes option 1 look careful. In fact, they generate the highest pressures and are the most likely to burst the tube.

Prevention
Most clogs can be prevented by flushing regularly with water before and after each medication, during continuous feeding at set intervals, and after checking residuals; giving medications one at a time in liquid form when possible; and never mixing medications with formula. Key point! For a blocked feeding tube, start with warm water and gentle push-pull using a large syringe; never reinsert the guidewire.

## 임상 시나리오

Unclogging a Feeding TubeDay 7 blocked tube
First try warm water with gentle push-pull using a 30–60 mL syringe; then an enzyme declogger per policy.

Small syringes such as 10 mL create high pressure that can rupture the tube. Cola is not first-line and may make formula clump.

Prevent clogs by flushing before and after medications and at set intervals during continuous feeding.

CautionNever reinsert the guidewire into a tube in the body; it can perforate the tube and the esophagus.

## 핵심 개념

- **Push-pull technique** — Alternating gentle pushing and pulling of a syringe plunger to loosen a feeding tube clog.
- **Enzyme declogger** — A product containing digestive enzymes that dissolves formula clots in a feeding tube.
- **Stylet** — A wire inserted into a feeding tube to stiffen it during insertion and removed afterward.
- **Tube occlusion** — Blockage of a feeding tube lumen by formula, medication, or kinking.

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