question about giving meds thru PEJ tube

[Lola77]

When you give meds thru a pt's PEJ do you crush the meds separately and put them into individual med cups, mix with water and administer each separately followed by a flush? I have always just thrown them all together, mixed with a little warm water to help them dissolve, then add about 20 CC water and administer them all together followed by a flush. I started to do this the other day at my new job and a nurse told me that I had to do them separately.

How do you administer meds thru a PEJ? What about a regular PEG?

Thank you for the input - I am a fresh nurse (6 mos) and still learning learning learning. . .

[Belmont_Murse]

Too bad they aren't going into the stomache...

Think about this.

When giving IV medication why do we have to hang so many seperate piggybacks? Why not just mix everything into one bag and infuse...its all going into the same blood right?

When you crush meds and dilute into a fluid you create a solution not unlike an IV med, except this solution is being infused into the jejunum.

I think that this logic is a bit misguided. The reason you cannot and do not mix meds together in IVPB's and intravenously at all is due to the portal of entry being much more direct to the heart and therefor increases the risk of med reactions creating extravation and phlebitis or, in the case of central lines, damgaging the heart.

Mixing your meds together in a slurry of sorts is not contraindicated unless some of those meds are EC, ER, or otherwise noted to be consumed without the presence of certain chemicals 2/2 absorption issues.

So you flush your PEG, you put one med in, then flush, then put one med in...etc. Guess where it all collects, in the gastric pouch and *gasp* gets all mixed together there. So you've basically made a much larger mixture inside the pt and have given them 100-300cc extra fluid in the process.

The caveat is the hospital policy. If it's policy to do one, flush, then another...then do it. It saves your butt in the long run. Get with your pharmacist and question the legitimacy of this and perhaps begin to compile research to affect change to save you time.

[mykrosphere]

i dont give them separately.

it just doesnt make any sense to me for some reason...

i have never seen anyone do this either, except a new grad we have who did this.

if its about keeping a tube patent, then im not sure the issue.

keeping a tube patent seems related to the drug youre crushing rather than whether there are multiple meds mixed together..

and giving meds through the stomach and meds through a vein are not really comparable!

[sunnycalifRN]

I google'd the topic and found this:

Gastrostomy Tube Management Clinical Information Sheet

interesting information. The answer is "it depends on the medication" and "consult your pharmacist".

[chenoaspirit, ASN, RN]

And also with IV administration...you have a risk of crystals forming when mixing noncompatiable meds...not a worry with administering PO meds into the gastric system. Ive never seen anyone do it seperately, it would cause alot more fluids to be admin, especially on one who is on fluid restriction. But whatever the hospital policy states, then thats what should be done. But I do not compare this to IV meds.

[Asystole RN]

I think that this logic is a bit misguided. The reason you cannot and do not mix meds together in IVPB's and intravenously at all is due to the portal of entry being much more direct to the heart and therefor increases the risk of med reactions creating extravation and phlebitis or, in the case of central lines, damgaging the heart.

Although the risks you mentioned are valid you are forgetting that many medications will actually react with one another, either disabling each other or reacting in some other unknown fashion. Mixing meds is generally a no-no. I can promise you I spend a lot of my day looking at what medications can be given y-site, be infused back-to-back and what medications need to be given seperately.

How does the portal of entry being much more closer to the heart have anything to do with phlebitis or extravation? Seperate issues...

I dare you to call your pharmacists and give him your rationale.

Mixing your meds together in a slurry of sorts is not contraindicated unless some of those meds are EC, ER, or otherwise noted to be consumed without the presence of certain chemicals 2/2 absorption issues.

Again call the pharmacist...I highly doubt he will say ok to crush and mix. Absorption issues are rarely the only issues.

So you flush your PEG, you put one med in, then flush, then put one med in...etc. Guess where it all collects, in the gastric pouch and *gasp* gets all mixed together there. So you've basically made a much larger mixture inside the pt and have given them 100-300cc extra fluid in the process.

Small potatoes but PEJ....not PEG.

[fiveofpeep]

its all going to mix in the same place. most of my patients are on fluid restrictions and I think it's redundant in general to separate them.

the only rationale I got to support separate containers was "what if the md d/cs the order while you are administering the medication?" well, my answer to that is, I wouldnt know anyways since when was the last time an md came into the room to tell me that they d/cd a medication?

[natrgrrl]

There are lots of different opinions but ultimately the right answer is to follow policy (IMHO).

Our policy is to separate each med and flush with 30cc between each different med given. That can be extremely time consuming considering how long it takes for J tube to empty by gravity, which is also our policy. I agree with these policies.