In 2005, the National Patient Safety Agency (NPSA) highlighted concerns about the management of nasogastric tubes following reports of unnecessary deaths because of misplaced feeding tubes in infants, children and adults. During 2006, I investigated the management of nasogastric tubes (NGTs) in children (Clarke and Richardson 2007a, 2007b). This systematic review divided primary papers into three principal themes: enteral feeding via the NGT; confirmation of NGT position and associated incidence of tube placement error; and hydration via the NGT for acute gastroenteritis in children. Findings of the review are summarised here in relation to using the nasogastric tube to administer medication to children with the aim of informing practice and improving safety.
"Furthermore, not all oral dosage forms are suitable for administering via NGT (e.g., slow release tablets, enteric coated tablets and irritating drugs) (Gilbar and Pract, 1999; Zhu and Zhou, 2013). Impaired stomach emptying, gut mucosa damage, intestinal and splanchnic hypoperfusion are further factors which can reduce drug bioavailability (Clarke, 2008; Gilbar and Pract, 1999; Sou9 cková et al., 2013). In practice, all these aspects result in a limited drug administration into gastrointestinal tract (do Nascimento et al., 2012). "
[Show abstract][Hide abstract] ABSTRACT: What is known and objective:
Administering oral medications to patients with nasogastric tube (NGT) is a challenging patient-care issue. Inappropriate prescribing behaviour and incorrect procedure for extemporaneous preparation of oral suspensions given via NGT may result in significant harm to patients. There are many drugs which have not been tested regarding oral absorption profile and bioavailability derived from NGT dosing. Although several studies and case-reports have been reported, there is no up-to-date review of drug administration via NGT. The aim of this review is to increase awareness of rational drug administration via NGT and to encourage relevant research in this area.
Full prescribing information from each currently available oral medication was reviewed for any data indicating that the medication could not be crushed or opened. Literature was identified by searching PubMed (1988 to Aug 2012).
Results and discussion:
There is evidence to show that NGT dosing of some medications may bring both benefits (e.g. cost saving) and disadvantages (e.g. decrease in efficacy and/or safety). For medications with package inserts that warn that they should not be crushed or opened, alternatives are usually recommended. However, in some cases, there is evidence to support NGT dosing. Sometimes special procedures are required to avoid problems such as instability, interaction with enteral nutrition, adsorption, tube obstruction and low recovery when preparing extemporaneous oral suspensions.
What is new and conclusion:
Physicians, pharmacists and nurses should know the procedures for drug administration by NGT, as well as the latest evidence on such administrations. There may not be bioequivalence between oral and nasogastric administrations. Care must be taken to avoid compromising the physicochemical, biopharmaceutical and pharmacological properties of drugs given by NGT to ensure their safety and efficacy.
Journal of Clinical Pharmacy and Therapeutics 04/2013; 38(4). DOI:10.1111/jcpt.12041edit · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To provide an overview of the current feeding tubes in use in the pediatric population including feeding tube complications, and specific guidance for patients at the initiation, throughout the use of, and at the discontinuation of tube feeding.
A review of the literature was performed using multiple databases including PubMed, CINAHL, Ovid Medline, and Cochrane Library. Key words used included pediatric gastrostomy (G) tubes, nasogastric (NG) tubes, gastrojejunostomy (GJ) tubes, enteral access, and nurse practitioner (NP).
Any child who cannot obtain nutrition orally is a candidate for enteral feeding tube access. Tube feeding is the recommended care guideline for children that are undernourished or unable to safely take-in oral nutrition. Tube feeding has been known to improve health-related quality of life. There are a number of different forms of feeding tubes that can be used in children, including NG, orogastric, G, and GJ tubes.
Children are being sent home regularly with enteral feeding tube access and NPs will encounter these patients in everyday practice. It is important that NPs know the risks and benefits of tube feeding as well as the types of tubes currently in use and their indications, advantages, disadvantages, and complications.
Journal of the American Association of Nurse Practitioners 11/2013; 25(11):567-77. DOI:10.1002/2327-6924.12075
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