Can JOURNAVZ be given concurrently with enteral jejunal (jejunal feeding through a tube directly into the jejunum) tube feeds?

Administration of JOURNAVZ with Jejunal Tube Feeds

JOURNAVZ can be safely administered concurrently with enteral jejunal tube feeds, as there are no specific contraindications to this practice in patients with functioning gastrointestinal tracts. 1, 2

Rationale for Concurrent Administration

• Enteral nutrition (EN) via jejunal feeding is recommended as the preferred route when patients have a functioning gastrointestinal tract but cannot tolerate gastric feeding 1, 2
• Jejunal feeding is particularly beneficial in patients who have demonstrated intolerance to gastric feeding or have gastric outlet obstruction 1
• Continuous rather than bolus feeding is typically required for jejunal administration due to the loss of the stomach reservoir function 3
• There are no specific contraindications to administering medications concurrently with jejunal tube feeds in patients with functioning gastrointestinal tracts 1

Best Practices for Administration

• When administering medications through jejunal tubes, ensure proper placement of the tube beyond the ligament of Treitz to optimize absorption 1, 3
• For medications administered through jejunal tubes:
  • Start with low flow rates (10-20 ml/h) and increase gradually due to limited intestinal tolerance in the jejunum 4, 2
  • Monitor for signs of feeding intolerance such as abdominal distension, pain, or increased output 1
• Commercial formula feeds are preferred over kitchen-made (blenderized) diets for tube feeding due to:
  • Consistent nutritional content 4
  • Lower risk of tube clogging 4
  • Reduced risk of microbial contamination 4

Special Considerations

• For patients with severe acute pancreatitis or other critical illnesses receiving jejunal feeding:
  • Nasojejunal feeding is the preferred route when digestive intolerance occurs 1
  • Monitor intra-abdominal pressure (IAP) during feeding, especially if IAP is elevated 1
• For patients with jejunal access through gastrojejunostomy tubes:
  • Position the gastrostomy to the right of midline and lower in the antrum to allow for a shorter, more direct route for the jejunal tube through the pylorus 1, 3
  • Use an extension tube of longer length to allow for deeper and more stable position in the jejunum 1, 3

Potential Complications to Monitor

• Tube dislocation or migration can occur and should be monitored, especially when administering medications 1, 3
• Mechanical issues such as tube kinking or coiling in the stomach can affect medication delivery 3
• Jejunal feeding may be associated with higher rates of diarrhea in some patients compared to gastric feeding 1

Algorithm for Administration

1. Confirm proper placement of the jejunal tube before administration 1
2. Administer JOURNAVZ according to its specific instructions
3. If administering concurrently with tube feeds, monitor for:
   • Signs of feeding intolerance 1
   • Proper medication absorption 2
   • Tube patency 4
4. If complications arise, consider temporarily separating medication administration from feeding times

By following these guidelines, JOURNAVZ can be safely administered concurrently with jejunal tube feeds while minimizing potential complications and ensuring optimal therapeutic outcomes.