Directions for administration of liquids
| IMPORTANT! - Never leave medication drawn up into a syringe unattended. Never give the syringe to someone else to administer to the patient. Accidental intravenous administration of oral / enteral medication drawn up in syringes has led to fatalities. |
Syringes - enteral tubes
Enteral syringes have a substantial dead-space at the tip, which should not be allowed to fill with liquid medicine. If this space fills with liquid, and if the syringe is then connected to an enteral tube, there is a risk of overdosage and / or leakage (with resulting medicine waste and contamination of the area). The dead-space can be prevented from filling by the use of appropriate bottle adapters or medicine straws which are available from the syringe manufacturers.
Some enteral syringes are single-use only, and others can be re-used for the same patient. Immunocompromised patients and those with enteral feeding tubes which terminate in the jejunum should usually be managed with single-use, sterile syringes.
All equipment used for administering medicines must be cleaned in between each use to prevent cross-contamination of medicines. Particular care should be taken when handling drugs to which patients frequently suffer allergies, e.g. the penicillins.
Syringes - oral
Dedicated oral syringes should be used to administer oral liquid medicines. The dead-space volume in these syringes is much smaller than in enteral syringes, but can still be significant in highly-concentrated drugs such as digoxin elixir when the dose volume is small. It is important to remember that the measured dose in these syringes is from the graduation mark to the base of the barrel - the tip of the syringe is designed to fill with liquid medicine, and should remain full after the dose has been given. This volume in the tip is in excess of the volume measured (i.e. it is not necessary to try and flush out the medicine which remains in the tip, and to do so would result in giving a dose in excess of what was intended).
Oral syringes are generally coloured to distinguish them from intravenous syringes. In centres where oral and enteral syringes are the same colour, the two should be stored separately and clearly labelled to avoid confusion. Oral syringes are not always sterile, and they may be re-used for the same patient. They should be clearly labelled with the patient details, washed in hot soapy water immediately after each use, and allowed to dry in air. Immunocompromised patients may require the use of sterile equipment to reduce infection risk.
Because of the dead-space at the tip of catheter-tipped and ISO 80369-3 enteral syringes, these syringes should generally not be used to administer liquid medicines orally.
Luer-tipped syringes should never be used to measure oral medicines, as this risks accidental connection of oral medication to intravenous catheters, and resulting intravenous administration and patient harm.
All equipment used for administering medicines must be cleaned in between each use to prevent cross-contamination of medicines. Particular care should be taken when handling drugs to which patients frequently suffer allergies, e.g. the penicillins.
Liquids / solutions - enteral tubes
Liquids are the preferred formulation for administration via enteral feeding tubes.
225 It is usually not necessary to dilute liquid preparations before administration (but see individual monographs for details). Liquids containing sorbitol may cause diarrhoea, therefore the highest strength product appropriate should be used in order to minimise sorbitol dosage. Sorbitol-containing liquids should be diluted before administration.
245
Flush the tube post dose with 10mL of water.
Syrups - enteral tubes
Syrups have viscous and hyperosmolar properties. It is best to dilute the syrup with the same volume of water before administration.
4,214
If the syrup is one of several drugs to be administered it is preferable to administer the syrup last.
Flush the tube post dose with 10mL of water.
Suspensions - enteral tubes
The majority of suspensions are suitable for administration via enteral feeding tubes, however some e.g. ispaghula husk (Fybogel
®) sachets for suspension, may block the tube. See individual monographs for advice.
Flush the tube post dose with 10mL of water.
Liquids / solutions / syrups / suspensions - swallowing difficulties
These are the preferred formulations for administering medications to patients with swallowing difficulties.
Injections
Use of injections via the enteral route is usually an expensive method of administration, and should be done only if there is no other suitable route or formulation. Not all injections are suitable to be given via the enteral route. Some are hypertonic, and some contain ingredients which are unsuitable for enteral administration, e.g. polyethylene glycol.
137 Only do this on the advice of Pharmacy.
Powder injections should be reconstituted with water for injections. All injections should then be diluted with 30-60mL of water before administration to reduce gastrointestinal side effects.133,137
Flush the tube post dose with 10mL water.
