Handbook of Drug Administration via Enteral Feeding Tubes.

Enteral feeding tubes are increasingly used to administer medications in the acute care, community care, and long-term care settings for patients receiving nutritional support. Medication administration through a feeding tube can present a number of challenges, including obstruction of the access device as well as the risk of decreased bioavailability of the medication due to interactions or delivery beyond the appropriate segment of the gastrointestinal tract. In addition, this form of administration is frequently outside of the product labeling. Although a number of articles have been published on the challenges of medication administration through enteral feeding tubes,1-4 health professionals have been lacking a comprehensive resource to guide their clinical decision making. The authors of the Handbook of Drug Administration via Enteral Feeding Tubes achieve their aim of supporting healthcare professionals in the safe and effective prescribing of drugs via enteral feeding tubes. This handbook was developed on behalf of the British Pharmaceutical Nutrition Group (BPNG). The first 10 brief chapters provide background knowledge on the legal, practical and technical aspects of administering medications via an enteral feeding tube. Topics covered include the key responsibilities of pharmacists; the different types, sizes, and positions for feeding tubes; the importance of tube patency; techniques for flushing, restoring, and maintaining tube patency; and the advantages and disadvantages for each medication formulation. There is a chapter on the types of syringes and ports highlighting options that are suitable or unsafe, and descriptions of different mechanisms for drug interactions when an enteral tube is used for medication administration. The legal, professional, safety, health, and risk-management implications of altering a drug's formulation and administration via an unlicensed route are summarized. The remainder of the book consists of 344 individual A to Z monographs containing guidance on the safe administration of specific medications. For each drug, product/administration information is listed with the site of absorption after oral administration, interactions, health and safety data, alternative routes, recommendations, and step-by-step instructions for intragastric and intrajejunal administration if these options exist. Recommendations are referenced with published literature, manufacturers' studies, and product material, as well as research conducted by the BPNG. Readers need to be aware that there are some differences in the brand names as well as formulations and strengths available in the United Kingdom compared to the United States (such as paracetamol [acetaminophen] infusion and zinc sulphate effervescent tablets). There are no other publications that provide a comprehensive reference for commonly used medications on dosage forms suitable for administration through an enteral feeding tube and the optimal technique to do so. Tertiary drug references contain some of the more basic information but typically lack data on the site of absorption or administration of medications by the intragastric or intrajejunal route. The Handbook of Food-Drug Interactions addresses the issue of medication administration through enteral feeding tubes as part of a 21-page chapter on drug interactions and enteral support, and Hospital Pharmacy has a periodic feature and a wall chart on oral medications that should not be crushed, but the Handbook of Drug Administration via Enteral Feeding Tubes stands in a class by itself.5-7 Written by experts in nutrition practice, with contributions from the pharmaceutical industry, this text has special relevance for the clinical practitioner making patient care decisions. The extensive references and evidence-based approach to decision making are an appealing feature. It will be an essential reference for drug information centers, medical libraries, and pharmacy departments, as well as a resource for health professionals caring for patients with enteral feeding tubes.