Administration of antiretroviral medication via enteral tubes (2022)

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Volume 69 Issue 24

15 December 2012

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Emily S. Prohaska, Pharm.D.,

Emily S. Prohaska, Pharm.D.

Clinical Coordinator

Address correspondence to Dr. Prohaska at Tria Health, 7101 College Boulevard, Suite 830, Overland Park, KS 66210 (eprohaska@triahealth.com).

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Allison R. King, Pharm.D.

Allison R. King, Pharm.D.

Clinical Assistant Professor

School of Pharmacy, University of Kansas, Lawrence, and Drug Information Specialist, University of Kansas Hospital

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American Journal of Health-System Pharmacy, Volume 69, Issue 24, 15 December 2012, Pages 2140–2146, https://doi.org/10.2146/ajhp120106

Published:

15 December 2012

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Abstract

Purpose

Case reports and other published or manufacturer-provided data on the administration of antiretroviral agents through enteral feeding tubes are reviewed.

Summary

There is very limited published evidence to guide clinicians in the delivery of therapies for human immunodeficiency virus (HIV) infection by feeding tubes, especially crushed tablets and capsule contents. A search of the primary literature (through February 2012) identified a total of nine articles describing the delivery of highly active antiretroviral therapy (HAART) agents via gastrostomy (G), jejunostomy, and other feeding tubes; correspondence with pharmaceutical manufacturers yielded additional information. Most of the published evidence (from two prospective studies, one retrospective study, and six case reports) pertains to the treatment of HIV-infected children (33 of 40 cases). Although not a primary endpoint of any of the reviewed studies, viral suppression was documented in 29 of the 40 patients referenced in the reviewed articles. Manufacturer-provided information indicates that crushed darunavir tablets in suspension, as well as oral solutions of ritonavir and lopinavir–ritonavir, can be administered through G-tubes without significant loss of therapeutic efficacy.

Conclusion

Data regarding enteral feeding tube administration are available for 63% of commercially available oral HAART agents and are primarily limited to case reports specific to the pediatric population.

© 2012 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

© 2012 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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FAQs

Are you able to give any oral medication via an enteral tube? ›

You should get consent to give medicines via an enteral feeding tube. Giving medicines this way is only covert administration if the person does not know they are being given the medicines. If medicines given via a tube are also given covertly, you must record this.

What are the concerns during medication administration through feeding tubes? ›

Incorrect administration methods may result in clogged feeding tubes, decreased drug efficacy, increased adverse effects, or drug-formula incompatibilities.

Why is it important to administer medications one at a time via feeding tubes? ›

Administer each medication separately. Each drug appropriate for administration through the tube should be administered separately to reduce the chance of tube clogging and drug interaction. There is a greater potential for drugs to interact with each other when pulverized into a powder and/or mixed in a fluid.

How do you administer medication through an enteral tube? ›

Feeding Tube Skills: Giving Medication - YouTube

What are the advantages of the enteral route of administration of drugs? ›

Enteral Administration. Oral (PO) administration is the most frequently used route of administration because of its simplicity and convenience, which improve patient compliance. Bioavailability of drugs administered orally varies greatly.

What does enteral administration of medication mean? ›

Enteral administration involves absorption of the drug via the GI tract and includes oral, gastric or duodenal (e.g., feeding tube), and rectal administration ▪ Oral (PO) administration is the most frequently used route of administration because of its simplicity and convenience, which improve patient compliance.

What types of medications Cannot be given via an enteral tube? ›

  • Table 1: Common Medications That Should Not Be Crushed.
  • Generic Name.
  • Brand Name.
  • Dosage Form.
  • Sustained-release Medications.
  • Enteric-Coated Medications.
  • Medications That Can Be Irritating.
  • Medications That Can Be Teratogenic and/or Carcinogenic.

What is a proper procedure for giving medications through a feeding tube? ›

How to Take Medication Through Feeding Tube - YouTube

What can happen when medications are infused along with enteral feedings? ›

Avoid mixing together medications intended for administration through an enteral feeding tube given the risks for physical and chemical incompatibilities, tube obstruction, and altered therapeutic drug responses (ie, do not mix medications together, but do dilute them appropriately prior to administration).

How do we prevent complications with enteral tube feedings? ›

To help prevent this problem, keep the head of the bed elevated 30 degrees or higher when possible. During patient transport or when placing the head of the bed flat for patient repositioning, turn the tube feeding off, especially if the patient has a high aspiration risk.

What are the disadvantages of enteral tube feedings? ›

There are disadvantages with enteral feedings. If the child has gastroesophageal reflux, aggressive enteral feeding may increase his risk of aspiration or vomiting. Other physical disadvantages are diarrhea, skin breakdown or anatomic disruption. Mechanical disadvantages include a dislodged or occluded feeding tube.

What is the purpose of enteral tube feeding? ›

Enteral nutrition, also known as tube feeding, is a way of delivering nutrition directly to your stomach or small intestine. Your doctor might recommend tube feeding if you can't eat enough to get the nutrients you need. When tube feeding occurs outside the hospital, doctors refer to it as home enteral nutrition (HEN).

What is the purpose of tube feeding? ›

Tube feeding is a therapy where a feeding tube supplies nutrients to people who cannot get enough nutrition through eating. A flexible tube is inserted through the nose or belly area to provide nutrients by delivering liquid nutrition directly into the stomach or small intestine.

What factors should be considered when administering a medication in a patient receiving tube feedings? ›

Considerations include the practical aspects of administration such as the formulation to be used, whether any interaction with the feed may occur, the type of tube and placement site, and the site of drug absorption.

How do you insert a enteral feeding tube? ›

Inserting an NG Feeding Tube - YouTube

What type of tube is used for enteral feedings? ›

The main types of enteral feeding tubes include: Nasogastric tube (NGT) starts in the nose and ends in the stomach. Orogastric tube (OGT) starts in the mouth and ends in the stomach. Nasoenteric tube starts in the nose and ends in the intestines (subtypes include nasojejunal and nasoduodenal tubes).

What is the best route of drug administration and why? ›

Because the oral route is the most convenient and usually the safest and least expensive, it is the one most often used. However, it has limitations because of the way a drug typically moves through the digestive tract. For drugs administered orally, absorption may begin in the mouth and stomach.

Why is enteral feeding better than parenteral? ›

In general, enteral nutrition is preferred to parenteral nutrition as it is more physiological, simpler, cheaper and less complicated. However even nasogastric feeding needs care and the more complex types of enteral nutrition such as gastrostomy and jejunostomy need significant interventions.

What is the most efficient route of administration of drugs? ›

Intravenous administration is the best way to deliver a precise dose quickly and in a well-controlled manner throughout the body. It is also used for irritating solutions, which would cause pain and damage tissues if given by subcutaneous or intramuscular injection.

What does enteral use only mean? ›

Enteral nutrition refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver nutrition and calories. It can include a normal oral diet, the use of liquid supplements or delivery by use of a tube (tube feeding).

Where is enteral medication absorbed? ›

Enteral Route of Medication

The primary site of drug absorption is usually the small intestine, and the bioavailability of the medication is influenced by the amount of drug absorbed across the intestinal epithelium. The first-pass effect is an important consideration for orally administered medications.

What are the common feeding administration methods for tube feeding? ›

Enteral feeding may be administered by various methods, including continuous, cyclic, bolus, and intermittent. The delivery method is determined by the tip location of the feeding tube (e.g., gastric, jejunal), the patient's clinical condition and tolerance to EN, and the overall convenience.

How can we prevent tube blockage due to medication administration? ›

Clogging can be prevented by flushing feeding tubes with 15–30 mL of water before and after drug delivery in order to minimize drug–formula interactions. Multiple medications should be given separately, with water irrigation between each one.

Can you take medication through a feeding tube? ›

Use liquid medicines whenever possible. Tell all your healthcare providers that you take medicines through your tube. Don't crush or dissolve extended-release or enteric-coated medicines unless directed by your healthcare provider. Don't mix medicines with feeding formula unless your healthcare provider says it's OK.

What is the best way to prevent a patient who is receiving an enteral feed from aspirating? ›

Follow these guidelines to prevent aspiration if you're tube feeding:
  1. Sit up straight when tube feeding, if you can.
  2. If you're getting your tube feeding in bed, use a wedge pillow to lift yourself up. ...
  3. Stay in an upright position (at least 45 degrees) for at least 1 hour after you finish your tube feeding (see Figure 1).
12 Jul 2022

Which is the main side effect of enteral feedings? ›

The most common side effects of tube feeding are nausea, vomiting, stomach cramps, diarrhea, constipation, and bloating. Other possible side effects may include: Infection or irritation where the tube is located.

What should you monitor during enteral feeding? ›

Monitoring should be done by suitably trained health care professionals, however patients on long term enteral feeding and their carers should be educated to monitor parameters such as bowels, weight and nutritional intake; identify potential problems; and report concerns to the relevant health care professional as ...

What is the most common problem in tube feeding? ›

Constipation. Dehydration. Diarrhea. Skin Issues (around the site of your tube)

When should you not use enteral feeding? ›

Currently, the only major contraindications to enteral nutrition seem to be bowel obstruction, perforation, mesenteric ischemia, or major gastrointestinal bleeding. In short, the patient can be fed as long as they aren't having an intestinal catastrophe.

What safety measures have to be maintained while the patient is receiving an enteral tube feeding? ›

Wear gloves when handling feeding tubes and avoid touching can tops, container openings, spikes and spike ports. Label equipment: Labels should include the patient's name and room number, the formula type and rate, the date and time of administration and the nurse's initials.

Which is the most serious complication of enteral tube feeding? ›

Aspiration. Aspiration is one of the most important and controversial complications in patients receiving enteral nutrition, and is among the leading causes of death in tube-fed patients due to aspiration pneumonia.

Which position should be used for a patient receiving an enteral feeding? ›

Position: Lying prone/supine during feeding increases the risk of aspiration and therefore where clinically possible the child should be placed in an upright position.

How do you prevent diarrhea after enteral tube feeding? ›

Try adding a soluble fiber product to your daily tube feeding regimen or switching to a fiber-containing formula to help make your stools more formed. Consider using probiotics, recognized by the National Center for Complementary and Alternative Medicine as effective in treating diarrhea.

What are the benefits of early enteral feeding? ›

Early nutritional support in the form of enteral nutrition provides important benefits in terms of the interaction between the gut and the systemic immune response in critically ill patients. It helps to maintain gut integrity and the physiologic stress response (Jabbar 2003; Kudsk 2002).

What are the two main methods of enteral feeding? ›

enteral nutrition when you have food directly into the stomach or small bowel. parenteral nutrition when you have food directly into a vein (PN)

When should a tube feeding be recommended? ›

When should a tube feeding be recommended? When a person has an inadequate oral nutrient intake for 2 - 4 days. When a person has severe diarrhea. When GI tract works, but patient cannot meet nutrient needs orally.

What are the concerns during medication administration through feeding tubes? ›

Incorrect administration methods may result in clogged feeding tubes, decreased drug efficacy, increased adverse effects, or drug-formula incompatibilities.

What are concerns of drug administration via feeding tubes? ›

Several issues must be considered with concurrent administration of oral medications and enteral formulas, particularly continuous tube feeding, because incorrect administration methods may result in clogged feeding tubes, decreased drug effectiveness, increased adverse effects, or drug–formula incompatibilities.

Should medications be mixed with tube feedings Why or why not? ›

Don't mix medications with feeding formulas.

Medications should not be added directly to the feeding formula. Mixing a drug with a formula could cause drug–formula interactions, leading to tube blockages, altered bioavailability, and changes in bowel function.

What are the 4 enteral routes of administration? ›

The enteral routes of administration are those in which the drug is absorbed from the gastrointestinal tract. These include thesublingual, buccal, oral, andrectal routes. Insublingual administration, a drug product is placed under the tongue.

What are the 5 steps you should follow in administering medication? ›

  • Right patient 4.
  • Right medication 4.
  • Right dose 4.
  • Right time 4.
  • Right route 4.
  • Right documentation 4.

What are the 4 types of drug administration? ›

Techniques involved in each route of medication administration are different, and some of the important points are summarized as follows:
  • Intravenous Route. ...
  • Intramuscular Route. ...
  • Subcutaneous Route. ...
  • Rectal Route. ...
  • Vaginal Route. ...
  • Inhaled Route.
17 Feb 2022

Which route of administration is best? ›

Oral route

Many drugs can be administered orally as liquids, capsules, tablets, or chewable tablets. Because the oral route is the most convenient and usually the safest and least expensive, it is the one most often used. However, it has limitations because of the way a drug typically moves through the digestive tract.

What is the most effective route of administration? ›

Intravenous administration is the best way to deliver a precise dose quickly and in a well-controlled manner throughout the body. It is also used for irritating solutions, which would cause pain and damage tissues if given by subcutaneous or intramuscular injection.

What types of medications Cannot be given via an enteral tube? ›

  • Table 1: Common Medications That Should Not Be Crushed.
  • Generic Name.
  • Brand Name.
  • Dosage Form.
  • Sustained-release Medications.
  • Enteric-Coated Medications.
  • Medications That Can Be Irritating.
  • Medications That Can Be Teratogenic and/or Carcinogenic.

What is the first thing you should do before administering medication? ›

Start with the basics
  • Verify any medication order and make sure it's complete. ...
  • Check the patient's medical record for an allergy or contraindication to the prescribed medication. ...
  • Prepare medications for one patient at a time.
  • Educate patients about their medications. ...
  • Follow the eight rights of medication administration.
9 May 2016

What are the 3 safety checks of medication administration? ›

WHAT ARE THE THREE CHECKS? Checking the: – Name of the person; – Strength and dosage; and – Frequency against the: Medical order; • MAR; AND • Medication container.

What is the correct way to administer medication? ›

Routes of medication administration
RouteExplanation
nasalgiven into the nose by spray or pump
ophthalmicgiven into the eye by drops, gel, or ointment
oralswallowed by mouth as a tablet, capsule, lozenge, or liquid
oticgiven by drops into the ear
12 more rows

When is enteral feeding used? ›

Indications for Enteral Feeding

Enteral tube feeding is indicated in patients who cannot main adequate oral intake of food or nutrition to meet their metabolic demands. Healthcare professionals commonly use enteral feeding in patients with dysphagia.

What are the advantages and disadvantages of enteral feeding route? ›

Tube feeding is a safer and less expensive alternative to feeding orally than total parental nutrition. There are disadvantages with enteral feedings. If the child has gastroesophageal reflux, aggressive enteral feeding may increase his risk of aspiration or vomiting.

How do you insert a enteral feeding tube? ›

Inserting an NG Feeding Tube - YouTube

What are the 3 main methods of drug administration? ›

Action may be topical (local), enteral (system-wide effect, but delivered through the gastrointestinal tract), or parenteral (systemic action, but delivered by routes other than the GI tract). Route of administration and dosage form are aspects of drug delivery.

What are the 7 steps of medication administration? ›

To ensure safe medication preparation and administration, nurses are trained to practice the “7 rights” of medication administration: right patient, right drug, right dose, right time, right route, right reason and right documentation [12, 13].

Which administration route provides the greatest drug absorption? ›

Intravenous (IV)

It is the fastest and most certain and controlled way. It bypasses absorption barriers and first-pass metabolism. It is used when a rapid effect is required, continuous administraction and large volumes.

Videos

1. Recent developments in antiretroviral therapy
(IAS Conference on HIV Science)
2. REPLACEMENT FEEDING// INFANT FORMULAS// INFANT FEEDING IN THE CONTEXT OF HIV/ AIDS//AFASS CRITERIA
(Nutrition by Stella Simon)
3. Pharmacology: Oral Meds Absorption
(GABAY MEDICAL library)
4. Session 3: Clinical Case Presentations with Panel
(Academic Medical Education)
5. IV Medication Administration: Using a Curlin Pump
(Option Care Health)
6. NCLEX RN CONCEPT SUMMARY QUICK REVIEW
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