View
216
Download
0
Category
Preview:
Citation preview
7/31/2019 drug administration in feeding tubes in ICU
1/53
Velia Marta Antonini, Parma University Hospital
I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
2/53
Administration viafeeding tube often
fallsoutside
licenseVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
3/53
becomeliableforanyadverseevent
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
4/53
becomeliablefortherapyfailure
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
5/53
complicationsobstructionoffeedingtubescross-contamination
exposuretopowders
environmentalcontamination
(patients)
(HCP)
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
6/53
equipment
avoidhandlingorinhaling
cytotoxicsagentshormones
antibiotics
egsteroids!
personal protective
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
7/53
tubes
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
8/53
nasogastricfeedingtube
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
9/53
duodenal-jejunal
feedingtube
caveats:length&diameter
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
10/53
PEG/PEJtubes
manageasnasalinserted
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
11/53
drugsformulations
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
12/53
soluble/effervescenttabs
dispersibletabletsbuccal/sublingualtablets
coated/uncoatedtabletshard/softgelatincapsules
modified-releasetablets
solid formulations
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
13/53
uncoatedtablets
crushadministeredimmediatelydo notmixpowdersVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
14/53
solubletablets
doseadjustmentisdifficultallowcompletedissolution
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
15/53
effervescenttablets
requirelargevolumes
producesCO2gwheninwater
caveats:gas&sedimentVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
16/53
coatedtablets
notcrushnorbreakVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
17/53
coatedtablets
ifadministeredin
small intestine tubemaybecrushedorcoatremoved
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
18/53
capsules(hard)
open&givecontent
if notmodifiedreleaseVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
19/53
capsules(soft)
drawfluidwithasyringeif notmodifiedreleasecompletedosingnotguaranteedVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
20/53
buccal
sublingual
chewable
cytotoxicagents
hormones&enzymes
neverto be
crushed
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
21/53
alternativeformulationalternativedrug
alternativeroute
neverto becrushedifessential
Velia MartaAntonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
22/53
liquidformulations
preferableifavailabledo notmix
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
23/53
liquid formulations
suspensions
solutionssyrupselixirs
linctus
Velia Marta Antonini, ParmaUniversity Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
24/53
liquid formulations
caveatsco-solvents
excipientsviscositygranulesize
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
25/53
paracetamol
highNainsolubletabletsoralliquidsarehyperosmolar
(acetaminophen)
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
26/53
oralliquidsare
hyperosmolar
metoclopramide
dilutewithat leastanequalvolumeofwater
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
27/53
do not useoralliquidtubesdueto
absorptionintoplastictubing
diazepam
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
28/53
lactulose
dilute3 timesbeforeadministrationviaND/NJ/PEJ
diluteavoiding
tubeobstruction
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
29/53
drug-feedinteractions
delayed -impaired
reduced -augmentedabsorption
bioavailabilityVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
30/53
drug-feedinteractions
stopfeedingbeforestopafterflushtube
how long?
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
31/53
small syringe=highpressure
30-50m l recommended
flush
maydamagetube/mucosa
uselargestfunctionalsize
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
32/53
avoidingocclusions
reducingtheformation&/orclearingdebrisbuilt-uponinnerwall
water flusheffective
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
33/53
tap/sterileH2O
sterileH2O
water flush
forgastrictubes
beyondthestomach
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
34/53
pulsatileflush=turbulencewithintheinnerlumen
moreeffectivecleaning
15-30m lbefore5-10m l betweeneach15-30m l after drug
water flush
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
35/53
sedimentinsyringepediatricptssmallboweltubes
15-30m l?relatestolumen
totalvolume
water flush
diameter&length!attention!
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
36/53
revisevolumes
takeaccountinbalancereplacewaterwithair
fluid restriction?
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
37/53
absorptionaffectedby
high-fibrecontainingfeeds
digoxin
stop 2hbeforestop 2hafter
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
38/53
isoniazid
rifampicin
stop 2hbefore
stop 2hafter
stop 2hbeforestop1/2hafterVelia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
39/53
bioavailabilityreducedtoup30%butnorecommendations
furosemide
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
40/53
decreasedabsorptionupto75%if
administeredwithfeed
absorptionextremely
poorviajejunalroute
stop 2hbefore
stop 2h after
phenytoin
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
41/53
enteralfeeddelaysbutnotdecreaseabsorption
stop 1hbeforestop 2hafter
quinoloneantibiotics
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
42/53
impairabsorptionbybindingwhen
containing
stop 1hbeforestop 1hafter
antacids
Al Mg Ca
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
43/53
levothyroxine
nodocumentedinteractionnofeedingbreakrequired
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
44/53
stop 2hbeforestop 2hafter
carbamazepine
impaired
absorption
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
45/53
drug-deviceinteractions
knowadministereddrugknowtubesinplace
youhave to
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
46/53
oralsyringes
do notusedevicescompatible
with IV ports & catheters
cathetertippedHandbookofDrugAdministrationviaEnteralFeedingTubes
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
47/53
catheter-tippedsyringes
do notmeasureliquid
drugs:riskofexcessivedosingowingtotipvolume
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia andIntensive Care
7/31/2019 drug administration in feeding tubes in ICU
48/53
dead-spacevolumeisapproximately11.5mL
catheter-tippedsyringes
VeliaMarta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
49/53
patencyoffeedingtubes
maincauseofocclusion
incorrectdrugadministration
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
50/53
obstructedfeedingtube
particleobstructionprecipitateobstruction
Velia Marta Antonini, Parma University Hospital - IDepartment of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
51/53
food-drug
drug-drugdrug-deviceinteractions
obstructedfeedingtube
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
52/53
irrigation
enzymesmechanicaldevices
unblockobstructedtube
Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care
7/31/2019 drug administration in feeding tubes in ICU
53/53
VeliaMartaAntoniniParmaUniversityHospital
IDepartmentofAnesthesiaandIntensiveCare
thanks forattention
Recommended