NG tube feeding/giving meds

Nurses General Nursing

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Hi everyone

I work on a unit where we do not get a lot of patients who have NG tubes and receiving feeding/medications through the NG tube. I have been a nurse for about 2 1/2 years. I remember working in the simulation lab during nursing school with NG tubes but because I rarely use this in current practice I have forgotten this skill. I have tried researching on my own but I just can't "picture giving feeding or medications through the NG tube" in my mind and I get confused.

I know how an NG tube is inserted and how to check for placement. I know that feedings are pumped through the kangaroo pump and attach it to the lumen of the NG tube. Now suppose you want to give medications (you would crush them and mix them with water and draw them up with a syringe correct) After stopping the feeding, do you leave the end of the feeding still in the NG tube or remove it and cap it so you can give the medications? Also how fast or slow should the medications go in? After giving medications your would then flush with water and then attach the feeding back?

Does anyone have videos or pictures demonstrating the above?

Thanks for all the help

Karou

700 Posts

Specializes in Med-Surg.
After stopping the feeding, do you leave the end of the feeding still in the NG tube or remove it and cap it so you can give the medications? Also how fast or slow should the medications go in? After giving medications your would then flush with water and then attach the feeding back?

Does anyone have videos or pictures demonstrating the above?

You have to remove the end of the formula tubing from the NGT to be able to attach your syringe to the NGT. You can cap it but most often we just hang it at the top of the IV pole so it's out of the way. Make sure you paused it first. Keep the NGT pinched so you don't get gastric contents leaking back on you. Then attach your syringe and push the medication in.

There is no set rate on how fast or slow to push the medication. You don't want to slam them in but you can push gently. Sometimes you can give by gravity and not push at all (attach syringe without plunger while holding upright, pour water already mixed with meds in and it will infuse itself by gravity). It can be time consuming and medication can get stuck though. Honestly I've only ever done that with G tubes/PEG's, not NGT's. You flush with a small amount of water before meds, between meds, and at the end. Then attach feeding back.

Remember if you are infusing anything into an NGT you must have a chest x rat first verifying placement. Check yourself also with air injection before meds. Check residual before meds to be sure your patient is tolerating and digesting the formula at the infusion rate. Your facility will have a policy on how much residual is too much and what to do about it. Keep HOB elevated at all times.

I am sure you can google videos on it. G-tube/PEG tubes are the same idea. Hope I helped. If you get someone on your unit with one ask to watch another nurse administer medication, that will help you.

Mr. Murse

403 Posts

Specializes in Critical Care/Vascular Access.

^ what they said.

Also, there are certain meds that recommend you stop the feed for a certain amount of time before and after administering the med (coumadin I think is one?), but it should say it on the MAR somewhere.

dexm

73 Posts

Specializes in ICU, ED.

We attach a lopez valve that connects the end of the NGT/DHT/PEG tube/whatever to the formula tubing and allows you to administer meds through the port at the top. Most of my pts have continuous TFs, so I usually don't stop them when I'm giving meds (unless it's something like dilantin, synthroid, etc. that require the TFs to be off 1hr before/after administration). I just turn the valve so it's "off" to the TF tubing, instill the meds with a 60 cc syringe, and then turn it back "off" to the port thing at the top so the TFs can resume infusing.

^ what they said.

Also, there are certain meds that recommend you stop the feed for a certain amount of time before and after administering the med (coumadin I think is one?), but it should say it on the MAR somewhere.

I think Dilantin is one you have to stop feeds before administration.

GayPhil

1 Post

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This journal article is quite useful, however probably only for those of us nurses in the UK (due to policies and procedures). We tend to measure the length of NG tubes and tape them in place, as well as draw aspirate from the tube to test the pH before administering meds. We don't always use X-ray for confirmation unless pH can't be confirmed or no aspirate can be taken.

nursearoo

49 Posts

Specializes in Peds.

Ph paper is the best way to check for proper placement...gastric Ph is below 5.5......also if the pt is on any meds like Pepcid, Zantac etc..anything like that it WILL affect the Ph so you should ask the MD what the acceptable Ph would be for verifying proper placement...years ago we used to do the air swish to check placement, however because it isn't really reliable, Ph is the best indicator for proper placement..... :-)

ixchel

4,547 Posts

Specializes in critical care.

When I've done meds via PEG, I've done it by gravity. Crush the meds and mix them in water (I do them individually so that if any don't go in and stay in for any reason, I know what went and what didn't). Have a cup of clean water available as well. Connect the giant syringe to the port, flush, and then remove the plunger. Pour each medication into the plunger as you hold it up, and you'll see the medications go in slowly and steadily. Be sure to pour in several ml of water to flush the tube between each medication and then flush at the end.

Youtube usually has videos of all procedures, good iuck:yes:

Specializes in SICU.

In my practice, we often use Corpaks (placed post-pyloric of course) and those are super easy to manipulate.

Sometimes when the anatomy of the patient makes a corpak unfeasible or they need TF for 1-2 days, they will have them infused through an NG tube, in that case, I simply add a corpak extension and its super easy giving meds!

psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.

Our hospital's policy (and the policy of everywhere I have worked as an RN) is that position must be confirmed by chest X-ray before giving a feeding through an NG. Air bolus is fine for confirming placement of an NG being used for suction, but there must be a chest x-ray before feedings.

Remember if it is to LIS you need to keep it clamped for 45 minutes

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