Enteral feeding and medicines administration

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

They are used in cases when a person has difficulty in swallowing or has an obstruction. The main types of enteral feeding tubes are:

• nasogastric (NG): passed through the nose into the stomach
• percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG): inserted through the abdominal wall into the stomach
• nasojejunal (NJ): passed through the nose into the jejunum (small intestine).

Consent to administer

You should always ask a person for their consent before giving medicines through an enteral feeding tube.  If a person lacks capacity to give consent, you must have a process for documenting these decisions, in line with the Mental Capacity Act 2005.

Considerations

Medicines administered through enteral feeding tubes are often not licensed to be given this way. The prescriber or appropriate healthcare professional must:

• clearly authorise the administration of medicines in this way
• provide specific guidance on how to prepare and administer each medicine safely.

When assessing a person's medicines support needs, check whether they can still take their medicines orally, even if they receive food through a tube. 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. Only prepare medicines this way if an appropriate healthcare professional confirms it is safe to do so.

Administer each medicine individually. Give the tube a flush of water (sterile water in some cases) before and after administering each medicine, and between different medicines. This prevents incompatibilities between medicines or with the nutritional feed.

Clearly record the volume of water used for each flush. Your record should consider whether the person is fluid restricted.

It is important that you do not:

• prepare medicines in advance to administer them later 
• leave medicines unattended.

Not all medicines can be administered through an enteral tube. For example:

• some oral liquids may not be suitable for tube administration
• some medicines may block or bind to the tube, making them unsuitable to be given in this way.

Always ask the prescriber, pharmacy professional or suitably qualified healthcare professional for guidance on the most appropriate way to administer each medicine

Staff competence

Make sure staff are:

• competent to support people who use enteral feeding tubes
• appropriately trained to prepare and administer medicines through enteral feeding tubes before carrying out this task – this includes preparing the medicines safely for administration and record keeping
• following infection prevention and control measures.

Records

Information should be available and accessible to staff on how to prepare and administer each medicine safely, including oral liquid medicines. The person's care plan should include:

• details of the medicines administered through an enteral tube
• all relevant information for administration, including when to seek advice or refer for specialist help.

Work with healthcare professionals to make sure people’s medicines are reviewed regularly and continue to meet their needs. Check whether the prescriber’s directions have changed. If any new medicines are prescribed, make sure staff have access to information on how to administer them safely.

Record each administration clearly on the medication administration record (MAR) or equivalent, including the route used.

Health and safety considerations

Crushing tablets or opening capsules can release dust, which increases the risk of inhaling or absorbing the drug through their skin. This is particularly important for:

• cytotoxic or teratogenic medicines
• antibiotics
• immunosuppressants
• hormones.

Carers should take precautions to reduce exposure - for example, by wearing gloves and dispersing tablets in oral syringes.

Where patients or carers cannot crush tablets or open capsules safely, consider requesting whether liquid medicines can be prescribed instead.

For practical guidance on how to crush and/or dispersing tablets and opening capsules, see Advising how to crush or disperse tablets and open capsules.