From the FDA Drug Label
The recommended loading dose and maintenance doses of CAFCIT follow Dose of CAFCIT (caffeine citrate) Volume Dose of CAFCIT (caffeine citrate) mg/kg Route Frequency Loading Dose 1 mL/kg 20 mg/kg Intravenous* (over 30 minutes) One time Maintenance Dose 0. 25 mL/kg 5 mg/kg Intravenous* (over 10 minutes) or Orally Every 24 hours** *Using a syringe infusion pump **Beginning 24 hours after the loading dose
The methods for caffeine delivery in a patient who is Nil By Mouth (NBM) and has a Jejunostomy (JEJ) tube are:
- Intravenous administration, using a syringe infusion pump, over 30 minutes for the loading dose and over 10 minutes for the maintenance dose. Note that oral administration is also mentioned, but this may not be suitable for a patient who is NBM. However, it can be administered through a feeding tube, which in this case is a Jejunostomy (JEJ) tube 1.
From the Research
For a patient who is nil by mouth (NBM) with a jejunal feeding tube (JEJ), caffeine can be administered through the tube using liquid caffeine preparations, with the recommended approach being to use caffeine citrate solution at a dose of 20 mg/kg loading dose followed by 5-10 mg/kg maintenance doses every 6-8 hours as needed, as supported by the most recent and highest quality study available 2.
Methods of Caffeine Delivery
When administering caffeine through a JEJ tube, it's essential to:
- Flush the tube with 15-30 mL of water before and after administration to prevent clogging
- Monitor for side effects like tachycardia, agitation, or insomnia, as absorption may be more rapid than oral administration
- Consider alternative methods, such as crushing caffeine tablets and dissolving them in warm water, although this may not be as reliable as using liquid caffeine preparations
Key Considerations
- The jejunal route provides reliable absorption similar to oral administration, though onset may be slightly faster due to bypassing gastric emptying
- Caffeine works by antagonizing adenosine receptors in the central nervous system, which helps improve respiratory drive, mental alertness, and can reduce fatigue
- The use of jejunostomy tubes is a common practice in patients who are NBM, and the administration of caffeine through these tubes can be an effective way to manage symptoms and improve patient outcomes, as seen in studies such as 3 and 2
Administration Guidelines
- Use caffeine citrate solution at a dose of 20 mg/kg loading dose followed by 5-10 mg/kg maintenance doses every 6-8 hours as needed
- Flush the tube with 15-30 mL of water before and after administration to prevent clogging
- Monitor for side effects and adjust the dose as needed
- Consider the patient's individual needs and medical history when determining the best course of treatment, as highlighted in studies such as 4 and 5