Unsuitability of sump tubes for delivery of enteral nutrition and medications to intensive care unit patients

Abstract

16 Fr Salem Sump™ tubes have special features to facilitate suction drainage of the stomach, including a second lumen for air venting. These tubes are also commonly used to deliver enteral nutrition and medications to intensive care unit (ICU) patients, but we found no previous research to justify this practice. Because of the unused air vent, these tubes have a large external diameter and a small bore infusion channel (no larger than that of a single lumen 12 Fr feeding tube). The causes of 16 Fr Salem Sump tube obstructions in 17 ICU patients included clogged medications (8 cases) and precipitation of feeding formula (7 cases), each of which would be promoted by a narrow bore. Because of multiple drainage holes at their distal end, these tubes cannot be thoroughly cleansed by standard water flushing; moreover, their drainage holes mandate a deeper length of tube insertion beyond the gastroesophageal junction, which increases the likelihood of intestinal or pulmonary perforation. For these reasons, we conclude that 16 Fr Salem Sump tubes are inferior to standard feeding tubes for delivery of enteral nutrition and medications to patients in medical ICUs.

Keywords:

• Acid-induced precipitation of formula
• complications of enteral nutrition
• crushed medications
• nasogastric tubes
• Salem Sump tubes

ACKNOWLEDGMENTS

We would like to thank the nursing staff of the medical ICUs at Baylor University Medical Center for their cooperation in the investigation of obstructed Salem Sump tubes. We also wish to thank Shameika Johnson for assistance with histopathology staining of the obstructed tube contents.