From the Guidelines
Medications that can be safely administered via PEG tube include most liquid formulations, but crushing tablets should be avoided whenever possible due to potential risks of exposure to the drug and inaccuracies of drug dosing 1. When administering medications via PEG tube, it is essential to consider the potential risks and benefits. The following medications should be avoided:
- Enteric-coated tablets, extended-release formulations, and sublingual medications, as crushing destroys their special delivery mechanisms
- Sucralfate, which forms a paste
- Bulk-forming laxatives, which can cause tube blockage
- Medications with narrow therapeutic indices like phenytoin, warfarin, and digoxin, due to unpredictable absorption It is crucial to consult with a pharmacist before administering medications through a PEG tube to ensure proper administration and avoid potential complications like tube obstruction or altered drug efficacy 1. Some key considerations when administering medications via PEG tube include:
- Using liquid formulations whenever possible
- Avoiding crushing tablets whenever possible
- Giving each medication separately with adequate water flushes (15-30 mL) before and after to prevent tube clogging and drug interactions
- Being aware of the potential risks of exposure to the drug and inaccuracies of drug dosing when crushing tablets is necessary
- Considering the osmolality of liquid medicines, as those with an osmolality >500-600 mOsm/kg can cause gut disturbances 1.
From the Research
Administration of Medications via PEG Tube
The administration of medications via a Percutaneous Endoscopic Gastrostomy (PEG) tube is a common practice in patients who have difficulty swallowing or are unable to take medications orally.
- Liquid medications, particularly elixirs and suspensions, are preferred for enteral administration via PEG tube, as they are less likely to cause tube occlusions compared to solid dosage forms 2, 3.
- However, it is essential to consider the sorbitol content of some liquid medications, as it may cause diarrhea 2.
- Before administering solid dosage forms via a PEG tube, it is crucial to determine if the medications are suitable for manipulation, such as crushing a tablet or opening a capsule 3.
- Medications should not be added directly to the enteral formula, and feeding tubes should be properly flushed with water before and after each medication is administered to prevent tube occlusions 3.
Contrast of Administrations via PEG Tube
Some studies have compared the effectiveness of different laxatives administered via PEG tube, including:
- Polyethylene Glycol (PEG) and lactulose, with PEG being more effective in treating chronic constipation 4.
- PEG plus an oral sulfate solution, which has been shown to be safe and effective in bowel preparation for colon capsule endoscopy 5.
Best Practices for Administration via PEG Tube
To ensure safe and effective administration of medications via a PEG tube, nurses should:
- Use a non-touch technique to reduce the risk of bacterial contamination 6.
- Recognize common complications of PEG feeding, such as tube occlusions and diarrhea 2, 3.
- Properly flush the feeding tube with water before and after each medication is administered 3.
- Consider the tube size and placement, as well as careful selection and appropriate administration of drug dosage forms 3.