PRESIDENT’S WELCOME:
Welcome to all of our new and current G.A.S.P.E.N. members!
The G.A.S.P.E.N. board is very excited about our programming this year. We are committed to providing nutrition support education and programming across all disciplines.
This year we are planning new programming events. We will host a journal club dinner meeting in
which we will review and discuss articles from The Journal of Parenteral and Enteral Nutrition (JPEN) that provide continuing education credits. Our first meeting will review parenteral fish oil in the critically ill. We are also planning to host an A.S.P.E.N. webinar for continuing education credits. Stay tuned for details!
I would like to thank Azy Armaghan, PharmD, BCNSP, our immediate past president for all of her leadership and service to G.A.S.P.E.N. over the past three years. Azy is still active on our board and we appreciate all of her hard work and dedication.
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Considerations for medication administration via feeding tubes
Adina Hirsch, PharmD, BCNSP
Enteral nutrition through a feeding tube is the preferred method of nutrition support in patients who have a functioning gastrointestinal tract and are unable to be fed orally. This method of delivering nutrition is also commonly used for administering medications for these patients. However, several issues must be considered with administration of oral medications and enteral formulas. Incorrect administration may result in clogged feeding tubes, decreased drug efficacy, increased adverse effects, and/or drug–formula incompatibilities. In this article, we are going to address some common problems associated with administering medications via feeding tubes and recommend some simple strategies to avoid these problems.
Decreased drug effectiveness:
Feeding tubes can be located in different locations in the GI tract (stomach, post-pyloric (duodenum) and jejunum).The effectiveness of certain drugs may be altered when given distal to the stomach. For example, ciprofloxacin is absorbed in the duodenum, and therefore, administering ciprofloxacin via a J-tube will decrease its efficacy since it’s being given distal to the site of absorption. Other medications that are absorbed in the duodenum are calcium, magnesium and iron. Unfortunately, there is little data available regarding the site of absorption of many medications, making drug administration via j-tubes very complicated.
Drug -formula incompatibilities:
Some medications are physically incompatible with enteral formulas. Acidic elixirs and syrups can denature the protein in enteral formulas, causing clumping or thickening. Therefore, the addition of medication directly to the enteral formula should be avoided. Mixing drugs with enteral feedings can result in physical incompatibilities, decrease drug absorption, and increase risk of tube occlusion. Specific incompatibilities include: Brompheniramine elixir, calcium glubionate, ferrous sulfate, guaifenesin liquid, potassium chloride liquid, pseudoephedrine hydrochloride syrup, and metoclopramide liquid. To avoid these incompatibilities, medications should be given as a bolus and separated from EN, and feeding tubes should be flushed with at least 15 mL of water before and after administration of medications.
Drug formulation considerations:
Sustained action tablets and capsules (SR, LA, XL, CD, CR, ER, XR, TD, TR, SA): Sustained action tablets should never be crushed. Choose an immediate release (IR) formulation instead. Some sustained action capsules can be opened and contents can be mixed with apple juice for administration. The acidity of apple juice helps prevent the beads from clumping and clogging the feeding tube. Orange juice is not recommended since the pulp may clog the feeding tube. Remind the nurse not to crush contents when mixing (e.g.: venlafaxine XR capsules sprinkle).
Enteric coated products: Enteric-coated products should not be crushed and altered for enteral administration since the enteric coating allows for medication to be released in the small intestine rather than the stomach. The small, crushed pieces can also clump together and clog the feeding tube. .
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