Enteral Access and Drug Administration

Question 1

What is a NG tube used for?

Answer 1

It is primarily used to remove gastric secretions to prevent aspiration, not for feeding.

It can be used to deliver drugs to the stomach.

Question 2

What is a G-tube used for?

Answer 2

It is used to deliver drugs and food and remove gastric content.

Question 3

Why can you not deliver fiber through J-tubes?

Answer 3

It can clog them.

Question 4

How can you deliver medications if a patient has a J-tube?

Answer 4

Use an oral syringe if possible.

Question 5

What must you do when establishing enteral access?

Answer 5

Use prokinetic agents (metoclopramide) and lay the patient on their right side.

Use an abdominal X-ray to confirm the GI location and make sure it’s not in the lung.

Question 6

What are the feeding techniques for EN?

Answer 6

Bolus=480mL 4 times during the day

Intermittent=240mL 8 times during the day

Continuous=80mL/hr

Feeding pumps

Question 7

What is the initiation speed of feeding techniques?

Answer 7

~10mL/hr to determine tolerance. You want to them advance the rate by 10-25mL/hr every 6-8hr if continuous.

Question 8

What can we dilute the isotonic formulas to for EN?

Answer 8

Don’t dilute them.

Question 9

What kind of protein is in EN?

Answer 9

Casein (intact proteins)
Small peptides
Free AAs

Question 10

What kind of carbohydrate products can be used for EN?

Answer 10

Simple (single sugars)
More complex (maltodextrin/corn starch)
Lactose free-for lactase free elderly and stressed
Soy or oat fiber, regulates bowel function

Question 11

What do long chain fatty acids require for absorption?

Answer 11

Lipase and bile salts.

Medium chains do not require lipase, but there is better absorption if lipase is present.

Question 12

What kind of fat enteral products are there?

Answer 12

Optimal ratio: 55%, which causes diarrhea

Question 13

Most EN products are ____ in sodium.

Answer 13

Low

Question 14

Renal product= __ electrolytes

Answer 14

no electrolytes or low electrolytes

Question 15

Heptic product=low ____

Answer 15

Low sodium

Question 16

For EN electrolyte products what does the product depend on?

Answer 16

The disease state the patient is in.

Question 17

Why do vitamin K amounts vary drastically in EN products?

Answer 17

Warfarin resistance has developed.

Question 18

If a patient has CHF or a traumatic brain injury how much EN volume do they need compared to normal patients?

Answer 18

They need less EN volume

Question 19

The more calories the ___ viscous the EN product.

Answer 19

more

High protein formulas are very thick.

Question 20

What is fibers role in EN products?

Answer 20

It regulates the large bowel.

Question 21

What is the free water content of EN Products?

Answer 21

50-85%

Question 22

What is Medicare Part B’s Reimbursement for EN?

Answer 22

Units=100 calories.

They base it off of the units given.

Question 23

How do you prevent tracheobronchial aspiration?

Answer 23

Elevate the bed 30 degrees
Use pump for accurate infusion rates
Observe for vomiting or excessive gastric residuals

Question 24

What can sorbitol cause?

Answer 24

Diarrhea

Question 25

What can cause diarrhea?

Answer 25

Hyperosmolar EN Sorbitol Long-term use of antibiotics Hypoalubinemia

Question 26

Can you add drug to the EN product?

Answer 26

No

Question 27

What happens when digoxin is delivered to the small bowel via FT?

Answer 27

There are higher levels so you need to decrease the dose.

Question 28

For EN administration where do we prefer to put cipro?

Answer 28

In the duodenum.

Question 29

What type medications cannot go down a FT?

Answer 29

``` Viscous, hypertonic, and things with an osmotic gap of >100mOsm/kg Acidic Medication (curdles intact protein) ```

Question 30

What happens when you put potassium chloride or guaifenesin down a FT?

Answer 30

It curdles the intact protein and can clog the FT.

Question 31

What happens when you mix elixirs with EN?

Answer 31

The alcohol in the elixirs can precipitate inorganic salts in the enteral formula.

Question 32

How can you give microencapsulated drugs?

Answer 32

Mix with water or acid and flush down the FT, do NOT CRUSH!

Question 33

How do you administer phenytoin using a FT?

Answer 33

Hold the TF 1 hour before and after each dose.

Question 34

How do you administer carbamazepine using a FT?

Answer 34

Dilute the suspension and monitro for efficacy

Question 35

How do you administer Itraconazole using a FT?

Answer 35

Hold TF one hour before and after each dose. Double the dose, but that increases chance of diarrhea

Question 36

How do you administer Tetracyclines using a FT?

Answer 36

They complex with di and trivalent cations. | Separate dose from EN or hold EN for an hour before and after and flush FT

Question 37

What drugs have physical incompatibilities with EN products?

Answer 37

Phenytoin, carbamazepine, itraconazole, tetracyclines, fluroquinolones, levothyroxin, and warfarin

Question 38

How do you prepare omeprazole for EN administration?

Answer 38

Dissolve it in bicarb and make it into a liquid preparation.