appendix 1:
Administration of medicines via enteral feeding tubes

• Narrow tubes and long tubes are more likely to become blocked

• In general for tubes < 8 Fr diameter, check with the ICU pharmacist before administering dose

• The correct formulation and effective flushing is required to prevent blockage

• Use equipment specifically designed for enteral administration to stop the risk of inadvertent intravenous administration

• Stop feed & flush the tube with 20 mL¹ water

• Give each medicine in a separate enteral syringe diluted appropriately before administering

• Prepare & administer one medicine before drawing up the next

• Flush the tube with 10 mL¹ water between each medicine to prevent interaction within the tube

• Flush the tube with 30 mL¹ water following administration of the last medicine

• Restart the feed if appropriate. The ICU dietician or pharmacist may advise a longer period for certain medication

1: Paediatric or fluid restricted patients may need smaller flush volumes. If unsure, please check with the ICU pharmacist or dietician

• DO NOT administer medicines via tubes being used for aspiration or those on free drainage

• DO NOT crush long acting/slow or controlled release tablets

• DO NOT crush enteric coated tablets

• For jejunal feedings tubes, some medicines may have decreased absorption due to the differing pH than that of the stomach. Discuss with the ICU pharmacist

• Consider withholding non-essential treatment if enteral tube administration is necessary

• Use liquid formulations in preference to tablets where available

• There may be differences in enteral tube administration between different available brands. If in doubt, please check with the ICU pharmacist