For anyone else who wasn’t aware Creon should not be administered via typical G-tube administration process:
- Mixing with thickened liquid (risk: tube occlusion; benefit: maintaining integrity of enteric coating which may preserve efficacy)
o Using a mildly thickened liquid as the vehicle is thought to reduce the risk of tube occlusion compared to using water or other thin liquid because a thin liquid allows the enteric-coated microspheres/beads to settle and clump together in the feeding tube.
o Adequate flushing of the feeding tube before and after administration is critical. If direct contact occurs between the acidic fruit juice and enteral feedings inside the tube, an interaction can occur that may clog the feeding tube.
o Some dietary experts have proposed the following technique, which can be used for tube sizes 10 Fr and above. However, if sizes 10 Fr or 12 Fr are in place, the use of low-dose enzyme capsules (3000—5000 units of lipase) are recommended because they contain the smallest sized microspheres/beads.
- Prepare 50—100 ml of mildly thickened fruit juice using a thickening agent (e.g., Nectar Thick).
- Open the pancrease capsule(s) into a small clean container.
- Add sufficient mildly thickened liquid to completely coat the microspheres/beads and stir gently to evenly suspend them in the liquid.
- If the patient is receiving continuous feedings, stop the tube feeds.
- Flush the feeding tube with an appropriate amount of water.
- Draw up the mixture with an enteral syringe of appropriate size for the volume and feeding tube size. Administer the mixture slowly through the feeding tube with slow, gentle pressure.
- Flush the feeding tube with water, and resume feeds.