Administration of JOURNAVZ with Jejunal Tube Feeds

Rationale for Concurrent Administration

The American Society for Parenteral and Enteral Nutrition recommends enteral nutrition via jejunal feeding as the preferred route when patients have a functioning gastrointestinal tract but cannot tolerate gastric feeding 3
Jejunal feeding is particularly beneficial in patients who have demonstrated intolerance to gastric feeding or have gastric outlet obstruction, with a strength of evidence level of moderate to high 4, 5
The American Gastroenterological Association suggests that continuous rather than bolus feeding is typically required for jejunal administration due to the loss of the stomach reservoir function, with a strength of evidence level of low to moderate 6
There are no specific contraindications to administering medications concurrently with jejunal tube feeds in patients with functioning gastrointestinal tracts, according to the Clinical Nutrition guidelines 1, 5

The Gastroenterological Society recommends ensuring proper placement of the tube beyond the ligament of Treitz to optimize absorption, with a strength of evidence level of high 7
When administering medications through jejunal tubes, start with low flow rates (10-20 ml/h) and increase gradually due to limited intestinal tolerance in the jejunum, as suggested by the Praxis Medical Insights guidelines 8
Monitor for signs of feeding intolerance such as abdominal distension, pain, or increased output, as recommended by the Clinical Nutrition guidelines 3
Commercial formula feeds are preferred over kitchen-made (blenderized) diets for tube feeding due to consistent nutritional content, lower risk of tube clogging, and reduced risk of microbial contamination, according to the Praxis Medical Insights guidelines 8

For patients with severe acute pancreatitis or other critical illnesses receiving jejunal feeding, nasojejunal feeding is the preferred route when digestive intolerance occurs, as recommended by the Clinical Nutrition guidelines 3
Monitor intra-abdominal pressure (IAP) during feeding, especially if IAP is elevated, as suggested by the Clinical Nutrition guidelines 3
For patients with jejunal access through gastrojejunostomy tubes, position the gastrostomy to the right of midline and lower in the antrum to allow for a shorter, more direct route for the jejunal tube through the pylorus, according to the Gastroenterology guidelines 7

Tube dislocation or migration can occur and should be monitored, especially when administering medications, as recommended by the Gastroenterology guidelines 7
Mechanical issues such as tube kinking or coiling in the stomach can affect medication delivery, according to the Praxis Medical Insights guidelines 6
Jejunal feeding may be associated with higher rates of diarrhea in some patients compared to gastric feeding, with a strength of evidence level of low to moderate 4