title: Efficacy of a Creon delayed-release pancreatic enzyme protocol for clearing occluded enteral feeding tubes.
abstract: BACKGROUND
  Alkalinized Viokase pancreatic enzyme tablets restored patency to 71.9% of occluded Dobhoff tubes in a prospective study. After removal of Viokase tablets from the US market, the hospital protocol for unclogging enteral feeding tubes was adapted to use Creon pancreatic enzyme delayed-release capsules, despite the lack of published data.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a Creon-based protocol to clear occluded enteral feeding tubes.
  
  
  METHODS
  This retrospective study included all adult and pediatric patients seen in the emergency department or in an inpatient setting who received Creon 12 000 units lipase delayed-release capsule dissolved in a solution of sodium bicarbonate 650 mg and sterile water for clearing occluded enteral feeding tubes between May 1 and November 30, 2010. The Creon protocol was deemed effective if tube clearance was documented in the medical record or if enteral feedings were resumed with no note regarding tube replacement.
  
  
  RESULTS
  Alkalinized Creon delayed-release capsules were administered to 83 patients with a total of 118 clogged tubes. Three poorly documented cases and 5 tubes with mechanical clogs were excluded from data analysis. Patency was restored to 53 of 110 (48.2%) occluded tubes. More than 1 treatment course was attempted in 5 cases, with success in 3.
  
  
  CONCLUSIONS
  An alkalinized Creon pancreatic enzyme protocol was effective in clearing approximately half of the occluded enteral feeding tubes in this retrospective study, an efficacy rate much less than that previously reported in the literature with a Viokase-based protocol.
authors.affiliation: University of Michigan Health System Department of Pharmacy Services, Ann Arbor, MI, USA.
authors.forename: Janice L
authors.initials: JL
authors.lastname: Stumpf
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Kurian
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vuong
authors.forename: Kimberlyn
authors.initials: K
authors.lastname: Dang
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kraft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D020799:Pancrelipase / Q000008:administration & dosage*; D012189:Retrospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D020799:Pancrelipase; D017693:Sodium Bicarbonate
keywords: enteral feeding tube; occlusion; pancreatic enzyme