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Velia Marta Antonini, Parma University Hospital I Department of Anesthesia and Intensive Care
outside license
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
become liable
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
become liable
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
complications obstruction
of
feeding
tubes
cross-contamination
(patients) (HCP) exposure
to
powders
environmental
contamination
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
tubes
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
nasogastric
feeding
tube
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
PEG/PEJ
tubes
drugs
formulations
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
solid formulations
soluble/eervescent
tabs
dispersible
tablets
buccal/sublingual
tablets
coated/uncoated
tablets
hard/soft
gelatin
capsules
modied-release
tablets
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
uncoated tablets
crush
administered
immediately
do not mix
powders
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
soluble tablets
allow
complete
dissolution
dose
adjustment
is
dicult
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
effervescent tablets
require
large
volumes
produces
CO2g
when
in
water
caveats: gas
&
sediment
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
coated tablets
coated tablets
if
administered
in
small intestine tube may
be
crushed
or
coat
removed
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
capsules (hard)
capsules (soft)
draw
uid
with
a
syringe
if not modied
release
complete
dosing
not
guaranteed
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
never
to be
crushed
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
never
to be
if
essential
crushed
liquid formulations
preferable
if
available
do not mix
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
liquid formulations
suspensions
solutions
syrups
elixirs
linctus
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
liquid formulations
caveats
co-solvents
excipients
viscosity
granule
size
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
paracetamol
(acetaminophen)
metoclopramide
oral
liquids
are
hyperosmolar
diazepam
do not use oral
liquid
tubes
due
to
absorption
into
plastic
tubing
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
lactulose
dilute
avoiding
tube
obstruction
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
small syringe
=
high
pressure
may
damage
tube/mucosa
use
largest
functional
size
30-50 m l recommended
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
flush
water flush
eective
reducing
the
formation
&/or
clearing
debris
built-up
on
inner
wall
avoiding
occlusions
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
water flush
pulsatile
ush
=
turbulence
within
the
inner
lumen
more
eective
cleaning
15-30 m l before
5-10 m l between
each
drug
15-30 m l after
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
water flush
15-30 m l ? relates
to
lumen
total
volume
attention!
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
fluid restriction?
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
digoxin
isoniazid
stop 2h before
stop 2h after
rifampicin
furosemide
phenytoin
decreased absorption up to 75% if administered with feed absorption extremely poor via jejunal route stop 2h before stop 2h after
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
quinolone antibiotics
antacids
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
levothyroxine
carbamazepine
impaired
absorption
stop 2h before
stop 2h after
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
oral syringes
catheter tipped
Handbook
of
Drug
Administration
via
Enteral
Feeding
Tubes
catheter-tipped syringes
do not
measure
liquid
drugs:
risk
of
excessive
dosing
owing
to
tip
volume
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
catheter-tipped syringes
dead-space
volume
is
approximately
11.5 mL
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
patency
of feeding tubes
obstructed
feeding tube
obstructed
feeding tube
unblock
obstructed
tube
irrigation
enzymes
mechanical
devices
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
thanks
for
attention
Velia Marta Antonini Parma University Hospital I Department of Anesthesia and Intensive Care