Advertisement

Practices Involved in the Enteral Delivery of Drugs

  • Kathryn S. BandyEmail author
  • Stephanie Albrecht
  • Bhavyata Parag
  • Stephen A. McClave
Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)
  • 7 Downloads
Part of the following topical collections:
  1. Topical Collection on Gastroenterology, Critical Care, and Lifestyle Medicine

Abstract

Purpose of Review

While the delivery of medications through enteral tubes is common in critically ill patients, there are complications and a lack of unified practices between institutions. The purpose of this review is to evaluate current practices and literature evidence regarding this administration route. The effect of this administration on the medication’s efficacy, safety, tolerability, and pharmacokinetics was examined, as well as other considerations to ensure that this route of delivery is both safe and effective for patients.

Recent Findings

Studies have found crushed oral tablets are the most frequent cause of obstructed feeding tubes. Complications such as this are primarily due to inadequate personnel training and failure to properly access medications before enteral administration.

Summary

There are many factors that should be considered in order to effectively administer drugs via enteral tubes. Formal training and use of a multi-disciplinary approach that includes pharmacists and dieticians has been shown to reduce tube obstructions and administration errors.

Keywords

Enteral nutrition Critical care Drug administration Adverse effects 

Notes

Compliance with Ethical Standards

Conflict of Interest

Kathryn S. Bandy, Stephanie Albrecht, Bhavyata Parag, and Stephen A. McClave declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Nathwani D, Lawson W, Dryden M, Stephens J, Corman S, Solem C, et al. Implementing criteria-based early switch/early discharge programmes: a European perspective. Clin Microbiol Infect. 2015;21(Suppl 2):S47–55.CrossRefGoogle Scholar
  2. 2.
    Cyriac JM, James E. Switch over from intravenous to oral therapy: a concise overview. J Pharmacol Pharmacother. 2014;5(2):83–7.CrossRefGoogle Scholar
  3. 3.
    Paladino JA, Sperry HE, Backes JM, Gelber JA, Serrianne DJ, Cumbo TJ, et al. Clinical and economic evaluation of oral ciprofloxacin after an abbreviated course of intravenous antibiotics. Am J Med. 1991;91(5):462–70.CrossRefGoogle Scholar
  4. 4.
    Belknap DC, Seifert CF, Petermann M. Administration of medications through enteral feeding catheters. Am J Crit Care. 1997;6(5):382–92.PubMedGoogle Scholar
  5. 5.
    Gora ML, Tschampel MM, Visconti JA. Considerations of drug therapy in patients receiving enteral nutrition. Nutr Clin Pract. 1989;4(3):105–10.CrossRefGoogle Scholar
  6. 6.•
    Institute for Safe Medication Practices (ISMP). Oral dosage forms that should not be crushed. Assessed at ismp.org. Updated 2019. This is an online resource provided by ISMP that lists oral medications that should not be crushed. The list also provides reasoning for the recommendations.
  7. 7.
    Williams NT. Medication administration through enteral feeding tubes. Am J Health Syst Pharm. 2008;65(24):2347–57.  https://doi.org/10.2146/ajhp080155.CrossRefGoogle Scholar
  8. 8.
    Beckwith MC, Feddema SS, Barton RG, Graves C. A guide to drug therapy in patients with enteral feeding tubes: dosage form selection and administration methods. Hosp Pharm. 2004;39(3):225–37.CrossRefGoogle Scholar
  9. 9.
    Leff RD, Roberts RJ. Enteral drug administration practices: report of a preliminary survey. Pediatrics. 1988;81(4):549–51.PubMedGoogle Scholar
  10. 10.
    Van den bemt PM, Cusell MB, Overbeeke PW, et al. Quality improvement of oral medication administration in patients with enteral feeding tubes. Qual Saf Health Care 2006;15(1):44–47.Google Scholar
  11. 11.
    Sacks GS. Drug-nutrient considerations in patients receiving parenteral and enteral nutrition. Pract Gastroenterol. 2004;28(7):39–48.Google Scholar
  12. 12.
    Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, et al. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr. 2009;33(2):122–67.CrossRefGoogle Scholar
  13. 13.
    Mcintyre CM, Monk HM. Medication absorption considerations in patients with postpyloric enteral feeding tubes. Am J Health Syst Pharm. 2014;71(7):549–56.CrossRefGoogle Scholar
  14. 14.
    Klang M, Mclymont V, Ng N. Osmolality, pH, and compatibility of selected oral liquid medications with an enteral nutrition product. JPEN J Parenter Enteral Nutr. 2013;37(5):689–94.CrossRefGoogle Scholar
  15. 15.
    Hill DB, Henderson LM, Mcclain CJ. Osmotic diarrhea induced by sugar-free theophylline solution in critically ill patients. JPEN J Parenter Enteral Nutr. 1991;15(3):332–6.CrossRefGoogle Scholar
  16. 16.•
    De brito-ashurst I, Preiser JC. Diarrhea in critically ill patients: the role of enteral feeding. JPEN J Parenter Enteral Nutr. 2016;40(7):913–23. This review article discusses a common issue in patients receiving enteral nutrition, diarrhea. The article highlights the potential etiologies, specifically considerations with medications that are administered via EN tubes. CrossRefGoogle Scholar
  17. 17.
    Chang SJ, Huang HH. Diarrhea in enterally fed patients: blame the diet? Curr Opin Clin Nutr Metab Care. 2013;16(5):588–94.CrossRefGoogle Scholar
  18. 18.
    Lutomski DM, Gora ML, Wright SM, Martin JE. Sorbitol content of selected oral liquids. Ann Pharmacother. 1993;27(3):269–74.CrossRefGoogle Scholar
  19. 19.
    Estoup M. Approaches and limitations of medication delivery in patients with enteral feeding tubes. Crit Care Nurse. 1994;14(1):68–72 77-9.PubMedGoogle Scholar
  20. 20.
    Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT. Recommendations for the use of medications with continuous enteral nutrition. Am J Health Syst Pharm. 2009;66(16):1458–67.  https://doi.org/10.2146/ajhp080632.CrossRefPubMedGoogle Scholar
  21. 21.
    Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust Prescr. 2016;39(3):76–83.PubMedPubMedCentralGoogle Scholar
  22. 22.
    American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, Third Edition. 2010.Google Scholar
  23. 23.•
    American Pain Society. Pain Management and Dosing Guide. 2016. Assessed from americanpainsociety.org. This includes the most recent guidelines for pain management from the American Pain Society. These guidelines discuss morphine equivalents and provide recommendations for transitioning between opioids.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kathryn S. Bandy
    • 1
    Email author
  • Stephanie Albrecht
    • 1
  • Bhavyata Parag
    • 2
  • Stephen A. McClave
    • 3
    • 4
  1. 1.Department of PharmacyUniversity of Louisville HospitalLouisvilleUSA
  2. 2.Department of PharmacyHouston Methodist Clear Lake HospitalHoustonUSA
  3. 3.Division of Gastroenterology, Hepatology, and NutritionUniversity of Louisville HospitalLouisvilleUSA
  4. 4.Department of Digestive and Liver HealthUniversity of Louisville Physicians Outpatient CenterLouisvilleUSA

Personalised recommendations