Enteral feeding and medicines administration

Enteral feeding tubes provide access to the stomach or small intestine.

They are used in cases where there is an obstruction or where a person has difficulty in swallowing. The main types of enteral feeding tubes are:

• nasogastric (NG): a tube passed through the nose directly into the stomach
• percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG): a tube inserted through the abdominal wall directly into the stomach
• nasojejunal (NJ): a tube passed through the nose directly into the jejunum (small intestine).

Consent to administer

You should get a person's consent to give medicines through an enteral feeding tube. Giving medicines this way is only covert administration if the person does not know they are being given the medicines.

If medicines given through a tube are also given covertly, you must record this. You must have a process for documenting these decisions taken, in line with the Mental Capacity Act 2005.

Considerations

Medicines administered through enteral feeding tubes are often not licensed to be given this way. The prescriber or appropriate healthcare professional needs to give:

• clear authorisation to administer medicines in this way
• information on how the medicines should be prepared and administered safely

When you are assessing a person's medicines support needs you should check whether they are still able to take their medicines orally, even if they are receiving food through a tube. This could be in their original form or after crushing or dissolving if appropriate. Not all tablets or capsules are safe to crush or open. You should only prepare them in this way if an appropriate healthcare professional can confirm that it's safe to do so.

Administer each medicine individually. You should give the person a flush of water before and after administering, and between each different medicine. This will prevent any incompatibilities between the different medicines, or the feed being given. You should clearly record the volume of flush needed each time. Your record should take into consideration if the person is fluid restricted.

It's important that you do not:

• prepare medicines in advance to administer them later 
• leave medicines unattended.

Medicines are not always suitable to be administered through an enteral tube. For example:

• it might not be appropriate to give an oral liquid in this way
• some medicines are not suitable to be given in this way as they may block or bind to the tube.

Always ask the prescriber or a pharmacist for guidance on the most appropriate way to administer each medicine.

Staff competence

You need to make sure that staff are:

• competent to support people who use enteral feeding tubes
• appropriately trained to prepare and administer medicines through enteral feeding tubes before they undertake this task
• following infection prevention and control measures.

Records

Information should be available and accessible to staff on how to prepare and administer each medicine safely, including oral liquid medicines. The person's care plan should:

• cover administering medicines through an enteral tube
• include all the relevant information, including when to seek advice or refer for specialist help.

Work with healthcare professionals to make sure people’s medicines are reviewed regularly and continue to meet their needs. Check if the prescriber’s directions have changed. For example, pain relief may be given using a transdermal patch.

Make a clear record of administration (including the route) on the MAR (medication administration record) or equivalent.