probably a very basic med question.....

[onthemark]

I have patients who take gel capsules (both colace and b12) but because the patients can't swallow these, I'm asked to open them and squirt in with their crushed meds. (Why they don't get these in pure liquid form, I don't know.) Does anyone know the best way of opening these gel capsules? One nurse said she pricks it with a needle, and others have told me they cut the capsules open with scissors. I feel there must be an appropriate way of getting the gel out and I wonder what anyone here might suggest. Thank you to whoever takes the time to answer this :)

[KelRN215, BSN, RN]

I recall having to do this with CoQ10 in the hospital. We poked the capsule with a blunt tip needle and then tried to squeeze the liquid out into a syringe. It turned our hands orange and the stuff had the consistency of paint. Try putting that down a G-tube and having any way of knowing that your patient got what they were supposed to get. Colace definitely comes in liquid so it's completely asinine to have to do what you're doing.

[morte, LPN, LVN]

had to check, CoQ10 come in a liq. also. didn't check the price, but I would hazard a guess you wouldn't get that one by the accountants....lol.

I recall having to do this with CoQ10 in the hospital. We poked the capsule with a blunt tip needle and then tried to squeeze the liquid out into a syringe. It turned our hands orange and the stuff had the consistency of paint. Try putting that down a G-tube and having any way of knowing that your patient got what they were supposed to get. Colace definitely comes in liquid so it's completely asinine to have to do what you're doing.

[KelRN215, BSN, RN]

had to check, CoQ10 come in a liq. also. didn't check the price, but I would hazard a guess you wouldn't get that one by the accountants....lol.

Yeah, occasionally we had people who brought in their own supply (which the pharmacy would refuse to verify because it was a liquid med and then we'd have to get an Attending MD to override and say we could administer it) but the hospital itself didn't carry the liquid version.

[onthemark]

The best bet seems to be MrChicagoRN's suggestion of a paper clip that can be cleaned before each use and then discarded. I'm going to try that today! Meanwhile, I'm relieved to report that the head nurse on another shift took the initiative and ordered the liquid colace! The other gel cap, though, (B Complex, not B12) is still being negotiated. Thank you all for your input!

[morte, LPN, LVN]

Ah, Bcomplex makes more sense. that can be obtained in a dry cap that can be opened. I wonder why they are paying extra for the gel cap??

The best bet seems to be MrChicagoRN's suggestion of a paper clip that can be cleaned before each use and then discarded. I'm going to try that today! Meanwhile, I'm relieved to report that the head nurse on another shift took the initiative and ordered the liquid colace! The other gel cap, though, (B Complex, not B12) is still being negotiated. Thank you all for your input!

[onthemark]

I tried the paper clip method today for the B Complex gel cap but it was difficult to puncture and then very difficult to squeeze it out from such a small hole. I ended up resorting to the scissors. I will pursue getting the liquid or the dry form suggested above by morte.

[pinkiepieRN]

How about Vitamin D? I've only ever seen it in a gel-cap!

Some of my patients too are ordered the gel-cap of Colace even though it exists in a crushable tablet form. Apparently this is the doing of the pharmacy for some reason. Is there a pharmacologic difference between the two - gel-cap vs. tablet? I assume there wouldn't be but one can never be too sure!

[morte, LPN, LVN]

Always follow the money.....I'm thinking it is cheaper to stock only one form, and the crushable maybe more expensive, haven't checked. Vitamin D does come in "dry" form, some feel it is not as well absorbed....but making sure there is sufficient fat in the diet helps. If you are dealing with the little Kelly green caps of vitamin D, that is D2 and is basically useless, you want D3. Good luck.

How about Vitamin D? I've only ever seen it in a gel-cap!

Some of my patients too are ordered the gel-cap of Colace even though it exists in a crushable tablet form. Apparently this is the doing of the pharmacy for some reason. Is there a pharmacologic difference between the two - gel-cap vs. tablet? I assume there wouldn't be but one can never be too sure!

[amoLucia]

Instead of syringe needles, use glucometer lancets.

[wooh, BSN, RN]

I put a blunt needle on a syringe, poke into the gelcap, and suck up the gel into the syringe. I then immediately squirt it into an oral syringe (or whatever the meds are going in for administration) so I don't inadvertently give it IV. Much less messy than squeezing the gel out.

[NurseJoy33]

I just snip the very tip off with a scissors, and squeeze.

[morte, LPN, LVN]

I think what all of the posters here need to realize, is that none of these "ways around" the problem are really appropriate. the dosage can not be accurate. Look at the bigger picture, not just the "task". the doc needs to be told to order differently, the pharmacy needs to understand that what they are providing isn't appropriate. Solve the problem instead of working around it. Would you be happy to receive an unknown, inaccurate dose of a med?