Contraindications for Tube Feeding and certain Medications

Pepper The Cat, BSN, RN · Nov 8, 2006

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.

NurseyBaby'05, BSN, RN · Nov 8, 2006

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.

leslie :-D · Nov 8, 2006

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

DDRN4me · Nov 8, 2006

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 .

gitterbug · Nov 8, 2006

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.

leslie :-D · Nov 8, 2006

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

Rnandsoccermom · Nov 9, 2006

Our docs routinely switch the Dilantin with Trileptal. The absorption rate is very unpredictable when giving dilantin and continuous tube feedings.

tatgirl · Nov 9, 2006

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