Pitfalls of administering drugs via nasogastric tubes.

Abstract

Crushing tablets and opening capsules before administration via nasogastric or enteral feeding tubes is a widespread practice. A survey of nursing homes in the UK reported that more than 80% crush tablets on at least a weekly basis, and 40% of nurses crush tablets on every drug round. In hospitals in Queensland, Australia, 104 different drugs were recorded as being altered at the bedside, with 84% of the drugs altered on a daily basis; tablet crushing accounted for 75% of alterations. However, data on the safety and efficacy of administering crushed tablets or opened capsules are limited. Patients may be harmed if the bioavailability of drugs is either impaired, resulting in reduced efficacy, or enhanced, resulting in toxicity. Mechanical failure of nasogastric tubes may also occur as a consequence of administering drugs. Finally, there are important medico-legal implications of administering altered oral drug formulations. This article highlights the problems associated with administering drugs via nasogastric or enteral feeding tubes, and suggests ways of improving the safety of this practice.