Enteral Access and Drug Administration Flashcards
What is a NG tube used for?
It is primarily used to remove gastric secretions to prevent aspiration, not for feeding.
It can be used to deliver drugs to the stomach.
What is a G-tube used for?
It is used to deliver drugs and food and remove gastric content.
Why can you not deliver fiber through J-tubes?
It can clog them.
How can you deliver medications if a patient has a J-tube?
Use an oral syringe if possible.
What must you do when establishing enteral access?
Use prokinetic agents (metoclopramide) and lay the patient on their right side.
Use an abdominal X-ray to confirm the GI location and make sure it’s not in the lung.
What are the feeding techniques for EN?
Bolus=480mL 4 times during the day
Intermittent=240mL 8 times during the day
Continuous=80mL/hr
Feeding pumps
What is the initiation speed of feeding techniques?
~10mL/hr to determine tolerance. You want to them advance the rate by 10-25mL/hr every 6-8hr if continuous.
What can we dilute the isotonic formulas to for EN?
Don’t dilute them.
What kind of protein is in EN?
Casein (intact proteins)
Small peptides
Free AAs
What kind of carbohydrate products can be used for EN?
Simple (single sugars)
More complex (maltodextrin/corn starch)
Lactose free-for lactase free elderly and stressed
Soy or oat fiber, regulates bowel function
What do long chain fatty acids require for absorption?
Lipase and bile salts.
Medium chains do not require lipase, but there is better absorption if lipase is present.
What kind of fat enteral products are there?
Optimal ratio: 55%, which causes diarrhea
Most EN products are ____ in sodium.
Low
Renal product= __ electrolytes
no electrolytes or low electrolytes
Heptic product=low ____
Low sodium
For EN electrolyte products what does the product depend on?
The disease state the patient is in.
Why do vitamin K amounts vary drastically in EN products?
Warfarin resistance has developed.
If a patient has CHF or a traumatic brain injury how much EN volume do they need compared to normal patients?
They need less EN volume
The more calories the ___ viscous the EN product.
more
High protein formulas are very thick.
What is fibers role in EN products?
It regulates the large bowel.
What is the free water content of EN Products?
50-85%
What is Medicare Part B’s Reimbursement for EN?
Units=100 calories.
They base it off of the units given.
How do you prevent tracheobronchial aspiration?
Elevate the bed 30 degrees
Use pump for accurate infusion rates
Observe for vomiting or excessive gastric residuals
What can sorbitol cause?
Diarrhea
What can cause diarrhea?
Hyperosmolar EN
Sorbitol
Long-term use of antibiotics
Hypoalubinemia
Can you add drug to the EN product?
No
What happens when digoxin is delivered to the small bowel via FT?
There are higher levels so you need to decrease the dose.
For EN administration where do we prefer to put cipro?
In the duodenum.
What type medications cannot go down a FT?
Viscous, hypertonic, and things with an osmotic gap of >100mOsm/kg Acidic Medication (curdles intact protein)
What happens when you put potassium chloride or guaifenesin down a FT?
It curdles the intact protein and can clog the FT.
What happens when you mix elixirs with EN?
The alcohol in the elixirs can precipitate inorganic salts in the enteral formula.
How can you give microencapsulated drugs?
Mix with water or acid and flush down the FT, do NOT CRUSH!
How do you administer phenytoin using a FT?
Hold the TF 1 hour before and after each dose.
How do you administer carbamazepine using a FT?
Dilute the suspension and monitro for efficacy
How do you administer Itraconazole using a FT?
Hold TF one hour before and after each dose.
Double the dose, but that increases chance of diarrhea
How do you administer Tetracyclines using a FT?
They complex with di and trivalent cations.
Separate dose from EN or hold EN for an hour before and after and flush FT
What drugs have physical incompatibilities with EN products?
Phenytoin, carbamazepine, itraconazole, tetracyclines, fluroquinolones, levothyroxin, and warfarin
How do you prepare omeprazole for EN administration?
Dissolve it in bicarb and make it into a liquid preparation.
