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Injectable & Enteral Medications
Transcript of Injectable & Enteral Medications
Ensure you know the size, type and position of the EFT before administering medication via tube
The exit site of the tube may affect pharmacokinetics or side-effect profile
Always check for tube placement before administering feedings and medications
Types of feeding tubes
Choosing a formulation
How to administer drugs via feeding tubes
Inadequate flushing most common cause of tube blockage
Wrong formulation of medication can also result in blockage
Narrow tubes and long tubes are more likely to become blocked
Acidic substances (orange juice or cola) may increase feed coagulation and should
be used to unblock tubes
Numerous products available to unblock tubes but little evidence to suggest they are more effective than water alone
If air flushing/flushing with warm water does not unblock tube, specialist advice should be sought - do not apply excessive force.
Medicines that should not be crushed
Enteric coated - the coating is designed to resist gastric acid to protect the drug and/or reduce gastric side effects
Extended release - specifically designed to release drug over long period of time. Crushing will cause drug to be released at once and may cause toxic side effects
Cytotoxics and hormones - risk to staff from exposure of the powdered form.
Antacids - the metal ions in the antacid bind to the protein in the feed and can block the tube
Certain antibiotics - levels of antibiotics can be significantly reduced by feed - consider other alternatives or increase doses
Switch off the feed if it is running
Check tube placement
Immediately flush the tube with water (30 mL)
Prepare the medicine as instructed
Give medicine down feeding tube
If a number of drugs are given at a time, flush with 15-30 mL of water between medications
Finally, flush tube slowly with 30-60 mL of water, ensuring the tube is clean
use plastic containers for mixing/crushing as the drug may adhere to the container
use boiling water as this may alter the bio-availability
administer any medicine via any route that you have not prepared yourself
add a drug directly to a feed container as this can lead to contamination or destabilize the feed/drug
Solutions or soluble tablets are the formulation of choice. Do not assume liquid formulation will be suitable and do not crush tablets or open capsules unless an alternative formulation of drug is unavailable.
Prepare each drug separately.
Never mix drugs unless instructed by a pharmacist.
Flush between medications
Consider therapeutic alternatives
BAPEN (2010), Drug Administration via Enteral Feeding Tubes, Produced by the British Association for Parenteral and Enteral Nutrition,
Potter, P., & Perry, A. (2017). Fundamentals of nursing (9th ed.). St. Louis, MO: Mosby Elsevier. (e-book)
Routes & Rate of Absorption
How do you verify correct tube placement?
Angle of insertion 5-15 degrees
Bevel up & Make a wheel
Assess site for changes
o.5 mL to site, don't cover or rub
Example: TB or allergy test
IM Injection Sites
IM injection sites
IM Injection Sites
Place the palm on the greater trochanter and the index finger toward the anterosuperior iliac spine