Administration of drugs via enteral feeding tubes

Drugs should only be administered via fine-bore enteral feeding tubes as a last resort and other routes of administration should be considered first. Most drugs are not licensed for administration via enteral feeding tubes.

Interaction can occur between drugs and the enteral feed. Clinically significant interactions include, phenytoin, digoxin, ciprofloxacin and rifampicin. A pharmacist should therefore be involved in any decision to administer drugs via this route.

Parenteral administration: aside of digestive tract.

Parenteral drug administration can be taken literally to mean any non-oral means of drug administration, but it is generally interpreted as relating to injection directly into the body, by-passing the skin and mucous membranes. The common routes of parenteral administration are intradermal, hypodermic, intravenous, intraarterial, into abdomen, pleural cavity, heart, intraspinal, into the bone marrow, morbid place.

Advantages of parenteral administration:

Drugs that are poorly absorbed, inactive or ineffective if given orally can be given by this route, unaltered form pass into the blood

The intravenous route provides immediate onset of action

The intramuscular and subcutaneous routes can be used to achieve slow or delayed onset of action

Patient compliance problems are largely avoided .

Disadvantages of parenteral administration:

Requires trained staff to administer

Can be costly

Can be painful

Difficulties or impossible applying in case of bleeding, skin eraption.

Aseptic technique is required. Before using syringes nurse should wash carefully hands under running water, wipe hands by individual towel, put gloves. Sterile material take only by the sterile tweezers.

May require supporting equipment for example, programmable infusion devices

NB: The correct administration of parenteral doses requires the use of appropriate injection technique. If performed incorrectly, for example using the wrong sized needle it can cause damage to nerves, muscle and vasculature and may adversely affect drug absorption.

Intramuscular and subcutaneous injection:

In general the injection of drugs into the muscle or the adipose tissue beneath the skin allows a deposit or ‘depot’ of drug to become established that will be released gradually into the systemic circulation over a period of time. By altering the formulation of the drug, the period over which it is released can be influenced. For example, the formulation of antipsychotic agents such as flupentixol in oil allows them to be administered once a month or every three months.

Complications: infiltration, abscess, necrosis, phlegmon, allergy reactions due to the aseptic breaks. Such as: not sterile syringes, not complete nurse hand processing, not correct infusion, not complete allergy anamnesis.

If aseptic rules was broken inflammatory infiltration appears. Pain in the place of injection, reddening, local high temperature. About complications doctor should know.

Warm compress should apply on this place.

If first aid was not provide – abscess could appear. High temperature, constant acute pain, expressed reddening, fluctuation. Call surgeon!

Prophylaxis of infiltrates and abscesses:

1. Manipulation sister should work in special dressing, observe rules of aseptic and antiseptic during injections.

2. Observe technique of injections. Medical needle 8sm, thin, according to subcutaneous fat.

3. Only sterile syringes.

4. Palpate tissues before injection. In case of deep consolidation don’t make injection.

5. Preparing oil solution injection should check that syringe needle is not in the vessel.

6. Don’t inject cold solutions. Oil sol. Warm – 37-38 C.

7. After injection recommend warm for better absorption.

8. Hypertonic solutions (analgin, magnesium) dilute by Novocain or physiologic sol. For quickly absorption.

Date: 2014-12-29; view: 923