Is Econorm (sodium picosulfate) effective when administered via a feeding jejunostomy (FJ) tube?

Econorm Sachet Administration via Feeding Jejunostomy

Econorm (Saccharomyces boulardii probiotic) can be administered via feeding jejunostomy tube, but requires proper preparation and careful attention to tube maintenance to prevent clogging, which is the most common complication of jejunal feeding.

Understanding the Product and Route

Econorm sachets contain a probiotic yeast that must be reconstituted in liquid before administration. The jejunal route presents specific challenges compared to gastric feeding:

• Jejunal tubes require controlled, slow delivery of all substances due to the jejunum's limited tolerance for bolus administration 1
• Tube clogging is the most frequent complication of jejunal feeding, occurring in 10.9% of cases in the early postoperative period and 8.2% in late follow-up 2
• Feeding pumps are strongly recommended for jejunal administration rather than bolus delivery to ensure controlled infusion rates 1

Preparation Protocol for Econorm via FJ Tube

Dissolve the sachet completely in at least 30-50 mL of room temperature water, ensuring no particles remain that could obstruct the narrow-bore jejunal catheter 1

• Flush the tube thoroughly with 30-50 mL of fresh water before administering the reconstituted Econorm 1
• Administer slowly over 15-30 minutes rather than as a rapid push, as jejunal tubes cannot tolerate rapid administration 1
• Flush immediately after with another 30-50 mL of fresh water to prevent residue from clogging the tube 1

Critical Tube Maintenance Considerations

The jejunal feeding tube must be flushed before and after every medication or feed administration:

• Use fresh tap water, cooled boiled water, or sterile water for all flushes 1
• Never use carbonated drinks or acidic juices (like pineapple juice) as these can degrade the tube material 1
• If the tube becomes blocked, attempt flushing with warm water first, then consider an alkaline solution of pancreatic enzymes if warm water fails 1

Timing Relative to Tube Feeds

• Separate Econorm administration from continuous tube feeds by pausing the feed, flushing the tube, giving the medication, flushing again, then resuming feeds 3
• For continuous pump feeding, this requires temporarily stopping the pump for the medication administration window 1
• Monitor for signs of feeding intolerance including abdominal distension, pain, or diarrhea after introducing any new substance through the jejunal tube 3

Common Pitfalls to Avoid

Never apply suction to jejunal tubes as they are fine-bore and not designed for mechanical stress, which can cause mucosal damage and tube collapse 4

• Avoid crushing tablets or using syrups through jejunal tubes; liquid suspensions or fully dissolved preparations are essential 1
• Do not administer hyperosmolar substances rapidly, as this can cause dumping syndrome or intestinal ischemia 5
• Confirm tube position if there is any question about placement before administering medications, as displaced tubes can lead to intraperitoneal administration 2

Expected Outcomes and Monitoring

• Tube patency should be assessed before each use by attempting to flush with water 1
• If resistance is met during flushing, do not force it; this indicates potential blockage requiring intervention 1
• Mechanical complications occur in approximately 12.9% of jejunostomy cases, with clogging being the most common 6
• Most complications are minor and manageable without requiring tube replacement or surgical intervention 2, 6