Contraindications for Tube Feeding and certain Medications

  1. 0
    Today Dilantin was held so a PEG tube could be stopped (Stop PEG for 1 hour, give Dilantin, restart PEG after 1 hour). The type of feed was "Nepro" (nutritional info, scroll down). How it was explained is that Dilantin clings to the "milk" in the tube feed and is excreted, thus not doing the body any good.

    I looked up the ingredients for Nepro and it doensn't say anything about having milk. I also looked up Dilantin and that says it binds to "albumin."

    Would you hold Dilantin if a patient was on tube feed (no matter the formula)?

    What other drugs would you have to hold if a patient were on a tube feed?


    Usage:
    NEPRO is specifically designed and clinically shown to meet the needs and altered metabolism
    of people on dialysis.

    * In a study of Nepro as sole-source nutrition, people on dialysis had:
    – Improved calcium-phosphorus product
    – Decreased phosphate binder use
    – Less constipation1
    * For tube or oral feeding
    * For supplemental or sole-source nutrition

    Features:
    # 1900 Cal (four 8-fl-oz cans) meets or exceeds 100% of the RDI for 18 key vitamins and minerals Low in vitamins A and D
    # High in folic acid and vitamin B6
    # Low in phosphorus and potassium
    # Moderate protein content to replace protein lost during dialysis and to help prevent catabolism of lean body mass
    # 3.7 g of FOS/8 fl oz (15.6 g/L). FOS are prebiotics that stimulate the growth of beneficial bacteria in the colon
    # 3 flavors (8 fl oz)—Vanilla, Cherry Supreme, and Butter Pecan
    # Low-residue
    # Lactose- and gluten-free
    # Kosher
    Caloric Distribution

    Per 8 fl oz

    Per Liter

    % Calories
    Calories
    475

    2000


    Protein, g
    16.7

    70

    14.0
    Fat, g
    22.7

    95.6

    43.0
    Carbohydrate, g*
    52.8

    222.7

    43.0
    Water, g†
    166

    699


    *Includes 3.7 g/8 fl oz (15.6 g/L) of FOS.
    †1 g water = 1 mL water = 1 cc water.

    Analysis:

    Hide details for Nutrient FactsNutrient Facts


    8 fl oz

    1000 mL
    FAN (label number) 7958-04 7642-01
    Cal/mL 2.00 2.00
    Energy, Cal 475 2000
    Protein, g 16.7 70
    % of total Calories
    14.0 14.0
    Fat, g 22.7 95.6
    % of total Calories
    43.0 43.0
    Cholesterol, mg
    <10 <30
    Carbohydrate, g 52.8 222.7
    % of total Calories
    43.0 43.0
    Water, g* 166 699
    Dietary Fiber, g 3.7 15.6
    L-carnitine, mg 62 261
    Taurine, mg 38 160
    m-Inositol, mg
    * 1 g water = 1 mL water = 1 cc water.
    Carbohydrate includes dietary fiber.
    Dietary fiber: 3.7 g/8 fl oz (15.6 g/L) of FOS.

    Hide details for VitaminsVitamins


    8 fl oz

    1000 mL
    Vitamin A, IU 1000 4215
    Vitamin D, IU 20 85
    Vitamin E, IU 12 48
    Vitamin K, mcg 20 85
    Vitamin C, mg 25 105
    Folic Acid, mcg 250 1055
    Thiamin (Vitamin B1), mg 0.6 2.6
    Riboflavin (Vitamin B2), mg 0.68 2.9
    Vitamin B6, mg 2.1 8.9
    Vitamin B12, mcg 2.4 11
    Niacin, mg 8 34
    Choline, mg 150 635
    Biotin, mcg 120 510
    Pantothenic Acid, mg 4 17
    Includes 750 IU/8 fl oz (3160 IU/L) of vitamin A activity from 0.57 mg/8 fl oz (2.4 mg/L) of beta-carotene.

    Hide details for MineralsMinerals


    8 fl oz

    1000 mL
    Sodium, mg (mEq) 200 (8.7) 845 (36.7)
    Potassium, mg (mEq) 250 (6.4) 1055 (27.1)
    Chloride, mg (mEq) 240 (6.8) 1010 (28.5)
    Calcium, mg 325 1370
    Phosphorus, mg 165 695
    Magnesium, mg 50 215
    Iodine, mcg 38 160
    Manganese, mg 1.3 5.3
    Copper, mg 0.5 2.1
    Zinc, mg 5.7 24
    Iron, mg 4.5 19
    Selenium, mcg 24 105
    Chromium, mcg
    Molybdenum, mcg



    Other Values
    Density at 23°C, g/mL 1.099
    pH 6.6
    Osmolality, mosm/kg H2O 665
    Osmolarity, mosm/L 446
    Renal Solute Load, mosm/L 491
    Cal to meet 100% RDIs 1900
    mL to meet 100% RDIs 947
    Total Cal/g nitrogen 179:1
    Nonprotein Cal/g nitrogen 154:1
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  3. 8 Comments so far...

  4. 0
    We also schedule Dilantin doses around our PEG tube feedings. We have also been told that the milk or milk sustitute binds with the dilantin. I can't think of any other med we do this with.
  5. 0
    We also would have to hold our Dilantin re: tube feeding. One way we worked with it was to get the docs or PA's to order the Dilantin 300mg qhs instead of 100 mg tid. That way the pt's feeding was only held for 2-3 hours total, instead of 3x a day. We would also try to get orders for Prosource or another supplement to boost the calories and nutrition that they were taking in.
  6. 0
    i've never held fdgs w/dilantin.
    our pharmacy told us that as long as we diluted it w/sterile water, dextrose 5% or 0.9% nacl, then flushed with minimum 20cc after administration, then nothing would stick to the tubing.
    dilantin can interact w/milk products but absorption is so variable that many md's do not consider milk a huge contraindication.
    there are too many other interferences w/dilantin, tube fdgs not being one of them.
    i know nurses have always held fdgs for an hr.
    but when i went to investigate why, the above, is what our pharmacy told us.
    and further research came up with similiar findings.

    leslie
  7. 0
    i have also mixed the dilantin with H20, and given with flushes both before and after. if the individual is not on a continuous feed it does help to schedule it when the feed is off. i have also found that crushing the chewables and diluting works better than the suspension, as it does not evenly distribute even when shaken..we found that dilantin levels drawn were quite inconsistent .
  8. 0
    Always flushed prior to administration of Dilantin and after administration of drug with plain tap water per pharmacy and doctor's orders. We are a little more generous than 20 cc. In fact, may give a total of 100cc if patient has no respiratory problems, abdomen is nondistended, bowel sounds are positive x 4 quads, and tube placement was verified x 2 nurses. Most patients who get tube feedings do not get recommended H2O intake, so urine is concentrated, giving a little extra water when able just promotes better urine output.
  9. 0
    Quote from gitterbug
    Always flushed prior to administration of Dilantin and after administration of drug with plain tap water per pharmacy and doctor's orders. We are a little more generous than 20 cc. In fact, may give a total of 100cc if patient has no respiratory problems, abdomen is nondistended, bowel sounds are positive x 4 quads, and tube placement was verified x 2 nurses. Most patients who get tube feedings do not get recommended H2O intake, so urine is concentrated, giving a little extra water when able just promotes better urine output.
    absolutely!
    i was just repeating what pharmacy told me- a minimum of 20cc.
    what many don't understand that despite continuous feeds, many of these pts do not get enough free water so in the absence of any contraindications, and w/the recommendations of the rd and md, we've given 500cc h2o tid-qid.

    leslie
  10. 0
    Our docs routinely switch the Dilantin with Trileptal. The absorption rate is very unpredictable when giving dilantin and continuous tube feedings.
  11. 0
    We have 2 residents on tube feeds that take Depakote, our orders are to stop the tube feed for 1 hour before and after giving the med, flush well while giving the med, and then restart feeding after 1 hour.


    Wendy
    LPN


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