NG tube question-please help!

[sweetieann]

Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

[aargo60]

Seems like a simple matter to me-medication should be given as the physician's order reads-po,im,ng, etc.-if you need clarification, the M.D. should be consulted. :)

Cindy B., LVN

[shigelin]

In most cases when a patient has an NGT they do not receive anything by mouth including their meds. You have to know what is wrong with the patient and why he has an NGT. It should also be in the nursing careplan. Nurses should always review the chart, a student nurse should ask the nurse overseeing her and her clinical instructor before proceeding with medication administration especially when in doubt. If it is not clear: Call the doctor.

[beanhead61]

Technically, whoever took the order from the MD should have clarified the order.There are some meds that NEED to be PO because they work buccally or whatever (Meds for thrush come to mind.) or they can't be liquified or crushed. (extended release). OR the patient's tube is a duodenal tube and the meds needs to dissolve in the acid environment of the stomach.

Also, it's very hard to swallow with a sump tube in! I generally use the tube unless ther's a reason not too.

Once again, clarify the order.

Don't be discouraged (if you're the student). This too will pass, and so will you if this is your worse transgression, unless there's more to the story.

It's a lesson you won't forget. Hopefully that's what the instructor wants.

[Tigger Nurse]

Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

I would always question a medication ordered PO on a patient with an NGT. Sometimes I think the Doc forgets what he wrote, but really wants the pt to receive the med. Some meds can be given IV instead and others via the NGT then clamping the tube for 30-60 mins. to allow the med to get past the stomach. I don't hesitate to bug the Doc. Afterall, he's the one who trusts us to care for his pt the other 23 hours he isn't there.

Diane Miller

[cajunnga]

I thought so too. In fact, I gave meds through NGT last semester with my primary nurse, but a little while later I removed the tube. My pt was NPO all she could have after removal was ice chips. The dr. may have "forgotten" to write NPO or could have just assumed everyone would know that because of the NGT. Sorry I ain't much help, but I see your confusion.

Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

[diablo]

Why use sterile water to flush the tube??

[lsyorke, RN]

Why use sterile water to flush the tube??

This is one of my pet peeves!! Does anyone DRINK sterile water??? I don't!!

[Tweety, BSN, RN]

Why use sterile water to flush the tube??

We use NS, 30cc q4h if it's NGT to suction.

But just use water if they are clamped or getting a feeding, usually flush with meds. Like above, it's it's good enough to drink, it's good enough to use with meds and a flush.

[sunflowerstt]

critical lover i could'nt have said it better myself good job! any information on verbal abuse in the theatre? i have to write a research paper on it. or nursing times booklet.

[neurotraumaRN]

when instilling meds via ng you should flush with 30ml sterile water pre and post-medication administration. do not mix meds together for administration, each med should be administered separately and followed with a 30ml flush. ngs need to be clamped 30 minutes after medications are administered to allow for absorption of the medication.

administering them each separately? you would be there all day! they are going to get mixed up in the stomach anyway, so what's the point of that? (depending on the amount of meds, you may also end up with a lot of flush in the stomach!!) i'd never heard that before, we always just mix them all together unless there is a specific contraindication. anyone else?

[DusktilDawn]

administering them each separately? you would be there all day! they are going to get mixed up in the stomach anyway, so what's the point of that? (depending on the amount of meds, you may also end up with a lot of flush in the stomach!!) i'd never heard that before, we always just mix them all together unless there is a specific contraindication. anyone else?

actually it is written into our hospital policy to give each medication separately and to flush before and after administration of each med.

http://www.pharmj.com/hospital/editorial/200006/features/managingdrugtherapy.html

if your care to read far enough to see:

panel 2: techniques for administering drugs via enteral feeding tubes23

1. crush tablets or open capsules and mix in10-15ml of tap water (5-10ml for children) rinse the tablet crusher and flush washings down the tube

2. dissolve dispersible tablets in 10-15ml of tap water

3. shake liquid formulations in the bottle

4. draw up medication into a 50ml needleless oral syringe

5. flush the nasogastric tube with 30ml of water before drug administration

6. administer each drug separately, flushing the tube with 5ml of water (3ml for children) in between each medication. flush the syringe in between medications

7. flush tube with water after administration is complete

and

http://www.ascp.com/public/pubs/tcp/1999/jan/tubes.shtml

again if you read far enough:

medication administration procedures

written guidelines for medication administration can provide nursing staff with clear steps to take to avoid tube occlusion and to optimize therapeutic response of the medication. table 1 describes a procedure for medication administration. general rules for delivering medications via enteral feeding tubes include the following:

use the oral route if at all possible.

if the tube must be used, use liquid medications.

flush the tube before and after the medication is administered with 30 ml of water.

dilute liquid medications with at least 30 ml of water to decrease osmolality.

avoid mixing any medications with the feeding formula.

if liquid medications are not available, check to see that the tablet medication can be crushed.

administer each medication separately to avoid drug-drug incompatibilities, and flush the tube well between with 15-30 ml of water. consider the timing of the medication; check to see whether it should be given on an empty or full stomach.

provide exact information about tube location to the dispensing pharmacist in order to best provide the correct dosage form. use only water to flush tubes, as cranberry juice or cola may actually promote tube occlusion.

although it is true that all medications eventually will end up in the stomach anyway, how can you be 100% certain there will be no drug interaction if medications are mixed together in a single container prior to administration and that they will not react together?

what specifically does the policies and procedures at your institution read concerning medication administration? do you know?

sorry, but i don't know of all the possible drug interactions that can occur by mixing pills that are crushed together, or mixing liquid forms together, or mixing 2-3 or heck 10 different meds together. do you?

it may take me longer to administer medication through an ng because i follow a policy and procedure designed to ensure patient safety, but the bottom line is, i'm doing it because it does ensure patient safety.

[coffeentea]

I know this does not really relate to the post. A NS asked me once what the mg in a medication order meant. I told her that I didn't think she was ready to give any medication to any patient. I don't know what was told to the instructor,but the instructor yelled at me at the nursing station that the students were there to learn and i should be more supportive. to make it worse she didn't even give me a chance to explain after yelling at me infront of other people. I believe that as a NS you are still responsible for following the 5 rights before giving any medication. TAKE RESPONSIBILY FOR YOUR ACTION.