Issue
|
Notes
|
Size of tube
|
·
Narrow
and long tubes are likely to become blocked by larger drug particles or
viscous solutions (2).
|
Tube site
|
·
Tubes
which terminate in the jejunum cause a particular concern for drug
administration as the tube may bypass the site of drug absorption and the
drug will be in the GI tract for a reduced amount of time.
·
Drugs
such as antacids, sucralfate, and bismuth are unlikely to work as they have a
local effect in the stomach (1).
·
Drugs
such as ketoconazole, which require an acidic environment to be absorbed
optimally, may have a reduced bioavailability (1).
·
Conversely,
increased bioavailability of some drugs such as opioid analgesics,
beta-blockers, and tricyclic antidepressants, may occur due to reduced
first-pass hepatic metabolism (1).
|
Tube Function
|
·
Tubes
which are being used for aspiration or drainage should not be used for drug
administration purposes.
·
This
is particularly important for multi-lumen tubes as care must be taken to
ensure drugs are administered into the correct lumen.
|
Feed timing
|
·
Feeds
may interact with drugs to reduce bioavailability.
|
Drug
|
·
Can
the drug be administered by a different route? E.g. intravenous, transdermal,
buccal etc.
·
Is
the drug essential?
·
For
a list of injections which may be given orally, see Q&A number 175.
|
Drug formulation
|
·
Modified
release formulations should not be given via a feeding tube.
·
More
viscous liquids e.g. syrups may clog tubes, as may larger drug particles.
|
Legal
Implications
|
·
For
most medications, administration through an enteral feeding tube is outside
product licences.
|
References
1. Toedter Williams N. Medication administration through enteral feeding
tubes. Am J Health Syst Pharm 2008; 65: 2347-2357.
2. White R and Bradnam V. Handbook of Drug Administration via Enteral
Feeding Tubes. (online). London : Pharmaceutical
Press; [Accessed via www.medicinescomplete.com
on 02/01/2014] 4-8.
3. Mason P et al. Nutrition-Supporting Pharmacy Services. CPPE open learning
programme. Outset Publishing: 2007, 80-85
4. National Institute for Health and Clinical Excellence. Clinical Guideline
32. Nutrition Support in Adults: oral nutrition support, enteral tube feeding
and parenteral nutrition. 2006, page 30-31. Accessed via http://www.nice.org.uk/nicemedia/live/10978/29979/29979.pdf
5. Stroud M, Duncan H and Nightingale J. Guidelines for enteral feeding in
adult hospital patients. Gut 2003; 52: vii1-vii12.
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