Problem solving
What do you do if giving several medications?
Do not mix drugs together during preparation, or in the syringe. Drugs are more likely to interact with each other if mixed together directly, particularly following tablet crushing. Also if the tube becomes blocked it may be difficult to determine how much of the dose has been given.
Administer each drug separately (see flow chart).
What can be done if the tube becomes blocked?
Adequate tube flushing and appropriate preparation of medications should reduce tube blockage. However if blockage does occur, first aspirate to try and remove any particulate matter, then flush the tube with warm water.
4,113,1171 Do NOT use excessive force.
1171
Other methods which have been tried include flushing the feeding tube with lemonade, sodium bicarbonate, cola or soda water. The combination of the acidity of these drinks, the effervescence due to carbonation and the flushing action may dislodge the blockage. However some sources consider the use of acidic drinks to contribute to tube blockage through protein denaturation.119
Another method involves adding the contents of three Pancrex V capsules and 1g of sodium bicarbonate powder to 20mL distilled water, instilling the solution into the enteral feeding tube and leaving it in the tube for twenty minutes before flushing with distilled water. Both the Pancrex V capsules and the sodium bicarbonate must be prescribed before this method is used.155
Are injectable drugs suitable to be used down the tube?
Some injectable drugs are suitable for oral administration and can be given via enteral feeding tubes, e.g. vancomycin, hyoscine. Injections with a high polyethylene glycol content are not suitable for enteral administration.
104 See individual drug monographs for advice.
Is it possible to add medication to the feed?
No, medication must never be added to feeds.
2 Changes in feed rate would alter drug dosage with a risk or under / over-dosing. There is a risk of microbiological contamination of the feed and there are difficulties in predicting the effect the feed will have on the physical characteristics and stability of the medication, and vice versa. Most medications are intended to be administered as discrete bolus doses, to achieve therapeutic peaks. The effect of administering medication over a prolonged period as would occur if medication was added to the feed is difficult to predict in most cases.
Some studies have investigated the effect of adding liquid medications to enteral feeds prior to administration as a way of tackling gastrointestinal intolerance due to the high osmolality of liquid dosage forms. In many cases, addition of medication results in altered pH of the feed, which may cause precipitation.25
Is it possible to add medication to soft food to aid swallowing?
Sometimes this may be done, but it is usually outside the marketing authorisation (product licence). When this is done, the medication should be added to the first mouthful of food so that the whole dose is given. Some medications can be added to fruit juice or other fluids for administration; see individual drug monographs for advice. Due to the potential for drug interactions, do not add drugs to grapefruit juice.
