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Administration viafeeding tube often

fallsoutside

licenseVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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becomeliableforanyadverseevent

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becomeliablefortherapyfailure

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complicationsobstructionoffeedingtubescross-contamination

exposuretopowders

environmentalcontamination

(patients)

(HCP)

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equipment

avoidhandlingorinhaling

cytotoxicsagentshormones

antibiotics

egsteroids!

personal protective

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tubes

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nasogastricfeedingtube

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duodenal-jejunal

feedingtube

caveats:length&diameter

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PEG/PEJtubes

manageasnasalinserted

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drugsformulations

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soluble/effervescenttabs

dispersibletabletsbuccal/sublingualtablets

coated/uncoatedtabletshard/softgelatincapsules

modified-releasetablets

solid formulations

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uncoatedtablets

crushadministeredimmediatelydo notmixpowdersVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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solubletablets

doseadjustmentisdifficultallowcompletedissolution

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effervescenttablets

requirelargevolumes

producesCO2gwheninwater

caveats:gas&sedimentVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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coatedtablets

notcrushnorbreakVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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coatedtablets

ifadministeredin

small intestine tubemaybecrushedorcoatremoved

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capsules(hard)

open&givecontent

if notmodifiedreleaseVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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capsules(soft)

drawfluidwithasyringeif notmodifiedreleasecompletedosingnotguaranteedVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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buccal

sublingual

chewable

cytotoxicagents

hormones&enzymes

neverto be

crushed

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alternativeformulationalternativedrug

alternativeroute

neverto becrushedifessential

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liquidformulations

preferableifavailabledo notmix

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liquid formulations

suspensions

solutionssyrupselixirs

linctus

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liquid formulations

caveatsco-solvents

excipientsviscositygranulesize

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paracetamol

highNainsolubletabletsoralliquidsarehyperosmolar

(acetaminophen)

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oralliquidsare

hyperosmolar

metoclopramide

dilutewithat leastanequalvolumeofwater

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do not useoralliquidtubesdueto

absorptionintoplastictubing

diazepam

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lactulose

dilute3 timesbeforeadministrationviaND/NJ/PEJ

diluteavoiding

tubeobstruction

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drug-feedinteractions

delayed -impaired

reduced -augmentedabsorption

bioavailabilityVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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drug-feedinteractions

stopfeedingbeforestopafterflushtube

how long?

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small syringe=highpressure

30-50m l recommended

flush

maydamagetube/mucosa

uselargestfunctionalsize

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avoidingocclusions

reducingtheformation&/orclearingdebrisbuilt-uponinnerwall

water flusheffective

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tap/sterileH2O

sterileH2O

water flush

forgastrictubes

beyondthestomach

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pulsatileflush=turbulencewithintheinnerlumen

moreeffectivecleaning

15-30m lbefore5-10m l betweeneach15-30m l after drug

water flush

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sedimentinsyringepediatricptssmallboweltubes

15-30m l?relatestolumen

totalvolume

water flush

diameter&length!attention!

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revisevolumes

takeaccountinbalancereplacewaterwithair

fluid restriction?

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absorptionaffectedby

high-fibrecontainingfeeds

digoxin

stop 2hbeforestop 2hafter

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isoniazid

rifampicin

stop 2hbefore

stop 2hafter

stop 2hbeforestop1/2hafterVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care

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bioavailabilityreducedtoup30%butnorecommendations

furosemide

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decreasedabsorptionupto75%if

administeredwithfeed

absorptionextremely

poorviajejunalroute

stop 2hbefore

stop 2h after

phenytoin

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enteralfeeddelaysbutnotdecreaseabsorption

stop 1hbeforestop 2hafter

quinoloneantibiotics

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impairabsorptionbybindingwhen

containing

stop 1hbeforestop 1hafter

antacids

Al Mg Ca

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levothyroxine

nodocumentedinteractionnofeedingbreakrequired

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stop 2hbeforestop 2hafter

carbamazepine

impaired

absorption

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drug-deviceinteractions

knowadministereddrugknowtubesinplace

youhave to

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oralsyringes

do notusedevicescompatible

with IV ports & catheters

cathetertippedHandbookofDrugAdministrationviaEnteralFeedingTubes

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catheter-tippedsyringes

do notmeasureliquid

drugs:riskofexcessivedosingowingtotipvolume

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dead-spacevolumeisapproximately11.5mL

catheter-tippedsyringes

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patencyoffeedingtubes

maincauseofocclusion

incorrectdrugadministration

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obstructedfeedingtube

particleobstructionprecipitateobstruction

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food-drug

drug-drugdrug-deviceinteractions

obstructedfeedingtube

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irrigation

enzymesmechanicaldevices

unblockobstructedtube

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VeliaMartaAntoniniParmaUniversityHospital

IDepartmentofAnesthesiaandIntensiveCare

thanks forattention