NG tube question-please help! - page 4
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."... Read More
- 0Sep 11, '05 by TweetyQuote from diabloWhy 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.
- 0Sep 11, '05 by neurotraumaRNQuote from dusktildawnwhen 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?
- 0Sep 11, '05 by DusktilDawnQuote from neurotraumarnactually it is written into our hospital policy to give each medication separately and to flush before and after administration of each med.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?
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
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.Last edit by DusktilDawn on Sep 11, '05
- 0Sep 11, '05 by coffeenteaI 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.
- 0Sep 11, '05 by Tigger NurseQuote from diabloWhy use sterile water to flush the tube??
Who told you that?! Totally unnessary! Tap water is fine...saline actually works better. We used to use coca cola, but they have banned that. It dissolved all the crap that would clog up a tube...just think what it does to your stomach lining! :angryfire
Diane Miller :chuckle
- 0Sep 11, '05 by tommycherOh my dusktildawn, you are extremely meticulous, must be a great nurse. Do you by any chance work in ICU, that is the only place I can imagine working and having the time to be this meticulous. Otherwise, giving meds via NGT while staying within your window of correct med times when you have 7 patients to assess and medicate would be impossible. But, kudos to you for being so precise and perfect. Practicing the 5 rights of med administration and being without a history med errors, I have yet to see anyone on the floor give meds via NGT, when ordered that way, not crush the meds together and dissolve enough to not clog the tube, and clamp if on suction.Last edit by tommycher on Sep 11, '05
- 0Sep 11, '05 by DusktilDawnTommycher, roughly how many patient's do you have that will have an NG on any given shift?
On a bad day, I may have 2.
Roughly how many meds are you administering via NG at any given time?
I've rarely had more than 5 medications that may have been needed be administered at one time.
Administering medications one at a time and flushing after each medication doesn't take hours, it takes a few minutes more. In this instance that few minutes more is worth it to me.
As I stated in my post, it is written into the policies and procedures at the facility to administer medications via NG this way.
BTW no I do not work ICU, I usually have a patient load of 6, and I am not perfect. I do the best I can.
Your snide sarcasm was completely unnecessary.
- 0Sep 11, '05 by cptvetteQuote from hrtprncssHaving read the number of resposes to this question, I offer the folowing consideration. NG tube in place compromises the gag reflex and increases the possibility of aspiration with administration of any thing P.O. This is a fact. In addition to the tube being in place the position of the patient is of sigmificant importance. Patient should be at at least 45 degree upright angle to decrease likelyhood of aspiration. Why the tube is in place is of importance to the overall question for all of the numerous answers. Instead of a punitive measure, the instructor should have taken this opportunity to make this a learning experience.Hey siri, I do understand although we assume that it is not on suction because if it is on suction you would not give it to the patient to swalow it either because it will be suctioned back up.