Can medications be administered through a gastrojejunostomy (gJ) tube?

Medication Administration Through Gastrojejunostomy (gJ) Tubes

Medications should preferentially be administered through the gastric port of a gastrojejunostomy tube rather than the jejunal port whenever possible, as the smaller diameter jejunal extension tubes (8-12 F) have extremely high occlusion rates of 3.5%-35% and frequent malfunction. 1

Critical Distinction: Gastric vs. Jejunal Port

A gastrojejunostomy tube has two separate ports:

• Gastric port (larger diameter): Medications should be administered here when possible to prevent tube clogging 1
• Jejunal port (8-12 F, smaller): Has 53%-84% malfunction rate due to tube occlusion, kinking, and clogging 1

Site-Specific Drug Delivery Considerations

Before administering any medication through either port, you must confirm the appropriateness based on the site of drug delivery, as some medications have significantly reduced bioavailability when delivered directly to the jejunum versus the stomach. 1

• Trovafloxacin administered directly into the duodenum/jejunum showed reduced drug availability compared to gastric administration 1
• The site of the tube tip directly impacts drug efficacy 1
• Many medications are designed for gastric absorption and may not work properly when delivered post-pylorically 1

Proper Administration Technique (When Jejunal Administration is Necessary)

If medications must be given through the jejunal port:

1. Flush with 30 mL of water before each medication 1
2. Administer each medication individually - never mix medications together 1
3. Flush with 30 mL of water between each medication 1
4. Flush with 30 mL of water after the final medication 1
5. Use ENFit-standard syringes and connectors to prevent fatal misconnection errors 1

Common Pitfalls and How to Avoid Them

High Tube Occlusion Risk

• The jejunal extension tubes clog in 3.5%-35% of cases 1
• Average jejunostomy tube longevity is only 3-6 months, with some studies showing median functional duration of just 39 days 1
• Tube occlusion is the second most common reason (22%) for tube replacement 1

Drug-Formula Interactions

• Certain medications bind to enteral formula (e.g., phenytoin) and must be administered separately from feeds 1, 2
• Stop enteral feeding, flush the tube, give medication, flush again, then resume feeding 1

Tube Migration

• Jejunal tubes migrate back into the stomach or duodenum in 27%-42% of cases 1
• This is the most common complication unique to gastrojejunostomy tubes (31% of replacements) 1
• When migration occurs, the tube generally must be replaced to achieve correct positioning 1

Low-Dose ENFit Syringe Issues

• Do not shake low-dose ENFit syringes to remove drug moat, as this exposes people to the drug and affects the delivered dose 1
• Take steps to avoid inaccurate dosing when using 1 mL or 3 mL low-dose ENFit tip syringes 1

Medication Selection Priorities

1. Use liquid formulations when available rather than crushed tablets 3, 2
2. Consult pharmacy before crushing any medication 3, 4
3. Verify the medication can be crushed - many cannot due to extended-release properties or enteric coatings 2, 4, 5
4. Consider alternative routes (IV, subcutaneous) for long-term administration if jejunal delivery is problematic 3

Drug-Tube Material Interactions

• Phenytoin binds to polyurethane enteral feeding tubes lubricated with polyvinylpyrrolidone 1, 2
• Polyurethane tubes are preferable to silicone tubes for medication administration due to better patency retention 1
• pH is an important factor in drug-tube interactions 1