title: Prophylactic pancreatic enzymes to reduce feeding tube occlusions.
abstract: 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.
authors.affiliation: Critical Care Services, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Bourgault
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: John W
authors.initials: JW
authors.lastname: Drover
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefe
authors.forename: Paula
authors.initials: P
authors.lastname: Newman
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day