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Enteral Feeding – PEG and NG Tubes

Learn more about enteral feeding tube users and the complexity of medicines administration.

There are an increasing number of enteral feeding tube (EFT) users in both hospital and community settings who are reliant on EFTs.[1]

They include:

  • Paediatric patients[2]
  • Stroke sufferers[3]
  • Patients with dementia[3]
  • Cancer patients[3]
  • Elderly[1]/Care home residents[3]
  • People with intellectual disabilities[4]

 

Medicines administration for these patients can be a challenge:[5]

  • It can be difficult to find a suitable drug formulation for administration to patients with limited gastrointestinal access or with dysphagia[1]
  • Only when other routes are shown to be unsuitable, should the EFT be used to administer medicines[5]

 

Crushing tablets for EFT administration has severe implications for patient care:[1]

  • Crushing with a pestle and mortar can result in 25% loss of drug. Patient and carer can be exposed to potentially harmful powder[1].
  • Modified release and enteric coated medication should never be altered without advice from a pharmacist[6]
  • Crushed tablets cause tube blockage in 15% of patients[5]
  • Re-siting a tube due to obstruction causes distress[5] for the patient and costs the NHS £964.43 – £1,829.67.[7]

 

NEWT guidelines suggest that liquids are the preferred formulation for administration via enteral feeding tubes.[8]

Rosemont have a range of liquid medicines licensed for use with PEG (percutaneous endoscopic gastrostomy) and NG (nasogastric) tubes. To view our range and administration guidance, please visit our product pages

ROS000046-002 DOP August 2023

References

  1. White R, Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes. British Pharmaceutical Nutrition Group. Pharmaceutical Press. 3rd edition. 2015.
  2. Lau R, Kharma N, Pardy C, et al G282(P) Gastrostomy prevalence in the paediatric population: a systematic review Archives of Disease in Childhood 2020;105:A103. Available at: https://adc.bmj.com/content/105/Suppl_1/A103.1. Accessed July 2023.
  3. Ojo O, et al. The Effect of Enteral Tube Feeding on Patients’ Health-Related Quality of Life: A Systematic Review. Nutrients. 2019 May; 11(5): 1046. Available at: https://pubmed.ncbi.nlm.nih.gov/31083338/. Accessed July 2023.
  4. Jory C, et al. Going Down the Tubes! Impact on Seizure Control of Antiepileptic Medication Given via Percutaneous Feeding Tubes. Epilepsy Behav. 2017 Sep; 74:114-118. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28732254. Accessed July 2023.
  5. Thomson FC, et al. Managing Drug Therapy in patients receiving enteral and parenteral nutrition. The Pharmaceutical Journal. 1 June 2000. Available at: https://pharmaceutical-journal.com/article/ld/managing-drug-therapy-in-patients-receiving-enteral-and-parenteral-nutrition Accessed July 2023.
  6. Wright D, Begent D, et al. Guidelines on the medication management of adults with swallowing Difficulties. Guidelines. MGP Ltd 2017.
  7. National Schedule of reference costs, 2020-21. NHS Trust and National Foundation Trusts. Published by NHS Improvement. Available at: 2_National_schedule_of_NHS_costs_FY21-22_v3.xlsx (live.com) Accessed July 2023.
  8. Directions for administration of liquids. The Newt Guidelines. Wrexham Maelor Hospital Pharmacy Department. Available at: http://www.newtguidelines.com/AdminOfLiquids.html Accessed July 2023.