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Enteral feeding and medicines administration

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Enteral feeding tubes provide access to the stomach or jejunum (small intestine).

They are used in cases where there is an obstruction or difficulty in swallowing. The main types of enteral feeding tubes are:

  • nasogastric (NG) - a tube passed through the nose directly in to the stomach
  • percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) - a tube inserted via the abdominal wall directly into the stomach
  • nasojejunal (NJ) - a tube passed through the nose directly in to the jejunum

Medicines given via enteral feeding tubes are often not licensed to be given this way. The prescriber needs to give:

  • clear authorisation for medicines to be given this way
  • information on how the medicines should be prepared and administered safely

Consent to administer

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. You must have a process for documenting these decisions taken, in line with the Mental Capacity Act 2005.

Considerations

Even though the person is being fed via a tube, you should check if they are still able to take their medicines orally. This could be in their original form or after crushing or dissolving if appropriate. Not all tablets or capsules are safe to crush or open. You should only prepare them in this way if confirmed by an appropriate healthcare professional.

You should administer medicines individually. You should give a flush of water given before and after administration, and between each medicine. This will prevent any incompatibilities between the different medicines, or the feed being given. You should clearly record the volume of flush needed each time. Your record should take into consideration if the person is fluid restricted or a child.

Do not prepare medicines in advance for administration later. Do not leave medicines unattended.

If a medicine could easily be given via an enteral tube, it is not automatically suitable for administration in this way. For example, it might not be appropriate to give an oral liquid via an enteral tube. Seek guidance on each medicine from the prescriber and, also, a pharmacist. Some medicines are not suitable to be given via a feeding tube as they may block or bind to the tube.

Staff must be appropriately trained to prepare and administer medicines via enteral feeding tubes before they undertake this task. This should include a regular competency assessment.

Records

Information should be available to staff on how to prepare and administer each medicine safely, including oral liquid medicines. The person's care plan should cover medicines administration via an enteral tube. It must include all the relevant issues, including when to seek advice or refer to specialist help.

Make sure people have a regular review of their medicine. You need to check if it is still required or if a more suitable or alternative medicine is available. For example, pain relief may be given via a transdermal patch.

Make a clear record of administration (including the route) on the MAR (medication administration record) or equivalent.

Last updated:
14 July 2020