Can medications still be given through a Nasogastric Tube (NGT) when there is a high output?

Medication Administration Through Nasogastric Tubes with High Output

Medications can still be administered through a nasogastric tube (NGT) when there is high output, but special precautions must be taken to ensure proper drug delivery and absorption. 1

Assessment Before Administration

• Check NGT placement and patency before medication administration
• Evaluate the volume and characteristics of the NGT output:
  • High output may indicate gastric dysmotility, obstruction, or malabsorption
  • Excessive output may dilute medications and reduce absorption
  • Consider if the medication will remain in the GI tract long enough to be absorbed

Administration Guidelines with High Output

1. Temporarily pause enteral feeding:

   • Stop feeding 1-2 hours before medication administration to maximize absorption 1
   • Resume feeding 30-40 minutes after medication administration for drugs that interact with formula

2. Proper preparation technique:

   • Use liquid formulations whenever possible (preferred over crushed tablets) 1
   • Crush tablets thoroughly to a fine powder and dissolve completely in water
   • Never crush extended-release or enteric-coated formulations 1

3. Administration procedure with high output:

   • Flush tube with at least 30 mL of water before medication administration 1
   • Administer medications individually (not mixed together) 1
   • Use appropriate ENFit syringes that comply with ISO standards 1
   • Flush with 30 mL of water after each medication 1

Special Considerations with High NGT Output

• Medication absorption may be compromised due to:

  • Reduced contact time with absorptive surfaces
  • Dilution by high fluid volume
  • Altered pH affecting drug stability 2

• Critical illness factors affecting drug absorption:

  • Gastrointestinal dysfunction may inconsistently affect drug dispersion 2
  • First-pass metabolism, microbiome alterations, and concurrent medications may influence absorption 2

• Tube placement considerations:

  • Medications are best absorbed when delivered to the stomach or proximal small intestine 1
  • Bioavailability may be reduced if administered distal to the stomach 1
  • The size and placement of the tube may influence drug dispersion and absorption 2

Monitoring and Adjustments

• Monitor therapeutic effect of medications administered via NGT
• Consider measuring drug levels for medications with narrow therapeutic windows 3
• Be prepared to adjust dosing if clinical response is inadequate
• Watch for tube occlusion which may be more likely with high output and medication administration

Contraindications

• Do not administer medications through NGT if there are:
  • Severe functional disturbances of the bowel
  • Gastrointestinal obstruction
  • Gastrointestinal tract bleeding
  • Severe malabsorption or metabolic imbalances 4

Practical Tips

• Consult with a pharmacist before crushing and administering medications through feeding tubes 1
• Consider alternative routes if medication absorption is significantly compromised
• Avoid hypertonic preparations which may cause gastrointestinal disturbances 1
• Document NGT output and medication administration to track effectiveness

Remember that high NGT output may significantly affect drug bioavailability, and therapeutic drug monitoring may be necessary to ensure adequate treatment.