Pushing meds through NGT/OGT with the plunger

[delphine22]

Had a pt with a husband who wrote EVERYTHING down. (Don't you love those.) Intubated/sedated/OGT. Giving her a med through the OGT like I always have -- take the open syringe, hook it up to the med port, hold it up around chest level, pour in my cup with the med and water, watch it go down, lift up a little if it's going slow, then pour in fresh water to flush.

Husband was floored. "I've never seen anybody do it like that!" he said. "They always push it in with the plunger."

I'll be honest, I've taken care of maybe 25 NGTs in my career before hitting the unit. I always did it this way. Here I've used the plunger once, because it was kinda stuck and my preceptor told me to. I also use it when I check residuals, and to return the residuals. (And for placement checks after inserting.) But I never felt comfortable using it for med administration.

Am I weird/overly cautious? Obviously if the tube's clogged all bets are off, let's get that sucker going. But if it's flowing freely, does anybody else skip the plunger?

[Do-over, ASN, RN]

I use gravity on G tubes, but plunger on naso/orogastric tubes.

[delphine22]

Kinda off topic, but has anyone else heard that dr pepper can unclog some NG tubes? A coworker mentioned it to me the other day and I had never heard it before. Obviously would be an off-label use lol..

I have been told to use Coke (not another type of soda like ginger ale or sprite) to unclog a tube. I've also read online that some nurses uses meat tenderizer!! Not something we generally keep on our unit, lol.

[MunoRN, RN]

I have been told to use Coke (not another type of soda like ginger ale or sprite) to unclog a tube. I've also read online that some nurses uses meat tenderizer!! Not something we generally keep on our unit, lol.

Cola really isn't a good idea anymore since it causes most modern tube feeding formulas to mineralize, literally creating a rock in the tube.

Even when it doesn't come in contact with tube feeding, tube manufacturers recommend not using cola since it can alter the smooth surface inside the lumen and make future clogs more likely.

[kysmommyrn, BSN]

I rotate between plunger and gravity. Basically if what I'm giving (meds, returning residual, etc) is more than a 60ml syringe will hold, I'll attempt gravity so I can just pour vs detaching syringe & refilling it.

[EuropaRN]

I always run my meds through by gravity (ng/og/peg) unless there's some resistance or if the meds get cloggy in the tube. That's just how I learned in school. If it's a small bowel feeding and there's no Lopez valve attached, and depending on how much I have to give I'll usually use a 10cc syringe and push through the small port, especially if it's just colace or a couple of pills.

[sarahicu]

60cc toomey syringe. I have always pushed my meds. I don't have time to wait for gravity, unless the md orders it ; )

[sarahicu]

As for unclogging coke does work. Another thing I have seen done is taking a guidewire from a mercury weighted feeding tube and inserting it into your clogged og/ng, it does break up the clogged area very well. Just be gentle don't go jabbing it in.

[NurseKatie08, MSN]

As far as unclogging, a Creon/Sodium Bicarbonate dwell will do the trick as well.

[WorldDay]

i remember a preceptee was doing this in ICU and the charge told her to "push it, you are acting like med surge nurse ."

[AliceTrout]

E'rry day I plunger it.

I saw a coworker try the coke thing and it backfired terribly. I haven't tried it since as I won't do anything I don't want to explain to a doc. (Yeah so the PEG wasn't flushing and so, ignoring our policy, I dumped a coke down it, and lo and behold that sucker mineralized before my very eyes! My bad!)

[pompomlady]

Heard the same thing! Cola/Dr Pepper - never actually tried it though but a more experienced nurse told me she had done it plenty of times....

[Bluebolt]

I usually assume people who use gravity method come from a long term care facility background. I precepted and was hired into the ICU as a new grad, I was always taught to use the plunger with syringe. If your vent patient starts to have a bronchospastic cough or anything like that your open flow method turns into a geyser of mess all over you and your patient.