From the Guidelines
For a patient who is nil by mouth (NBM) and has a jejunal feeding tube (JEJ), caffeine can be administered through the JEJ tube using liquid caffeine preparations, such as caffeine citrate solution, to minimize the risk of tube clogging and ensure effective delivery. The recommended approach is to use a liquid preparation, as crushing caffeine tablets is not advised due to the potential for excipients to clog the tube or have unpredictable absorption in the jejunum 1. For adults, a typical dose is 100-200 mg (5-10 mL) administered through the JEJ tube every 6-8 hours as needed. Alternatively, caffeine sodium benzoate injection (125 mg/mL) can be diluted and administered via the tube at similar dosages.
Key Considerations for Administration
- Before administration, temporarily stop tube feeding to prevent interference with caffeine absorption
- Flush the tube with 15-30 mL of water before and after administering the caffeine solution to prevent tube clogging
- Resume feeding after the caffeine administration is complete
- Monitor for side effects such as tachycardia, hypertension, or agitation, especially in patients with cardiovascular conditions
Preventing Tube Clogging
- Routine water flushing after feedings can help prevent tube occlusion, especially in small-caliber tubes like jejunostomies 1
- If the tube becomes clogged, simple water flushing can help regain patency
- Avoid using carbonated drinks or pancreatic enzymes to unclog the tube, as they may enhance the risk of tube contamination with bacteria or are not evidence-based practices 1
From the FDA Drug Label
The duration of treatment in this study was limited to 10 to 12 days. The protocol allowed infants to be "rescued" with open-label caffeine citrate treatment if their apnea remained uncontrolled during the double-blind phase of the trial A 1 mL/kg (20 mg/kg caffeine citrate providing 10 mg/kg as caffeine base) loading dose of CAFCIT was administered intravenously, followed by a 0.25 mL/kg (5 mg/kg caffeine citrate providing 2. 5 mg/kg of caffeine base) daily maintenance dose administered either intravenously or orally (generally through a feeding tube)
The methods for caffeine delivery in a patient who is Nil By Mouth (NBM) and has a Jejunostomy (JEJ) tube are:
- Intravenous administration: a loading dose of 20 mg/kg caffeine citrate, followed by a daily maintenance dose of 5 mg/kg caffeine citrate
- Oral administration through a feeding tube: a loading dose of 20 mg/kg caffeine citrate, followed by a daily maintenance dose of 5 mg/kg caffeine citrate 2
From the Research
Methods for Caffeine Delivery in NBM Patients with Jejunostomy Tube
- Caffeine can be delivered through a jejunostomy (JEJ) tube, which is placed surgically and is indicated when gastric feeding is unsafe or impossible 3.
- There is no direct evidence on the methods for caffeine delivery in patients with a JEJ tube, but studies suggest that medications and nutrients can be administered through these tubes 4, 5, 6.
- A study on the delivery of topiramate extended-release capsules through enteral feeding tubes, including jejunostomy tubes, found that the beads from the capsule can be passed through the tubes using gentle syringe pressure and appropriate diluents 7.
- The study on topiramate delivery suggests that caffeine or other medications could potentially be delivered through a JEJ tube using a similar method, but further research is needed to confirm this 7.
- The general risks of enteral tube feeding, including diarrhea, metabolic derangements, and aspiration, should be considered when administering caffeine or other substances through a JEJ tube 3.