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:)

[Tigger Nurse]

Why 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

[tommycher]

Oh 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.

[DusktilDawn]

Tommycher, 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.

[cptvette]

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.

Having 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.

[tommycher]

Dusktildawn, I am sorry if I appeared to be sarcastic, you are very thorough, and I meant my compliment sincerely. Our pharmacy has meds timed on our MAR, and designated as such, when they are to be given on an empty stomach, which are compatible and which are not. This is a secondary safety measure to compliment that which we should already know on our own. I do crush together compatible meds, and am aware of the route, etc. And of course, if it is an NGT to suction, the stomach is void of food anyway. I never give crushed and dissolved meds via Dobhoff, too much chance of a clog, and now we have these new peg tubes that are enteral and have feeding going along with suction, these are impossible to give meds through unless the meds are liquid. Anyway, I agree with the above postings, did not mean to be sarcastic, and we use drinking water to flush with.

[tommycher]

And by the way, the instructor is ultimately responsible for a student giving meds in clinicals. The instructor should have asked the student all of the appropriate questions before the meds were given, such as, what did the physician order say regarding dose, route and times. If the student did not know one of those answers, she needed to find out the answer before the meds were given, but that is why they have instructors. This instructor blew it.

[DusktilDawn]

Dusktildawn, I am sorry if I appeared to be sarcastic, you are very thorough, and I meant my compliment sincerely. Our pharmacy has meds timed on our MAR, and designated as such, when they are to be given on an empty stomach, which are compatible and which are not. This is a secondary safety measure to compliment that which we should already know on our own. I do crush together compatible meds, and am aware of the route, etc. And of course, if it is an NGT to suction, the stomach is void of food anyway. I never give crushed and dissolved meds via Dobhoff, too much chance of a clog, and now we have these new peg tubes that are enteral and have feeding going along with suction, these are impossible to give meds through unless the meds are liquid. Anyway, I agree with the above postings, did not mean to be sarcastic, and we use drinking water to flush with.

Tommycher, I appreciate that you clarified that it was not your intent to be sarcastic. Since we can't shake hands on a BB.... :cheers:

Pharmacy at my facility does not list medications incompatibilities in regards to NG administration on our MARS, nor is there a reference source for checking compatibilities. So until policies and procedures at my facility change and pharmacy includes incompatabilities on the MAR, it's just going to take me a few minutes longer to administer medicaitons via NG. Your pharmacy is much more thorough than ours.

Sterile water is what is stated in our policies for use with NG flushes and knowing how "clean" the sinks at my facility are, I prefer to use the sterile water anyway and keep it at the pt's bedside.

I'm so glad we don't very often get Dobhoff tubes, it is such a headache to get some residents to change meds to liquid or IV so that they don't clog.

tommycher:

And by the way, the instructor is ultimately responsible for a student giving meds in clinicals. The instructor should have asked the student all of the appropriate questions before the meds were given, such as, what did the physician order say regarding dose, route and times. If the student did not know one of those answers, she needed to find out the answer before the meds were given, but that is why they have instructors. This instructor blew it.

The OP left out a lot of details about what occurred and as I stated in an earlier post, there may be alot of details she doesn't know about. The student listened to instructions from the staff nurse. The fact that nursing instructors are responsible for students may actually be why the instructor wrote up a med error. Sorry not changing my mind on this issue unless more info comes to light.

[tommycher]

Certainly, if the student gave the meds without the instructor present, did not follow instructors instructions, then it was a med error. Students were kicked out of our program for such a thing.

[che3277]

Hello!

Just read your question about NPO, and if it is ordered whether the patient has NGT or not, meds or food and liquid is not suppose to be given to the patient. Except when the doctor has ordered that patient should be placed on NPO except meds this means that whether the patient has ngt or not meds has to be given either by mouth or by NGT. I hope I had give you some insight. :) And this also means that if the patient is placed on NPO and has an NGT still he is also not supposed to receive anything either by mouth or NGT.