crushing medications for pegs/ngts and for mixing in food for patients...
I'm 2 months into being a new nurse. at my facility almost every patient has a peg tube. I've been doing the "proper" way, crushing each med separately, and having mini cups and not mixing any together and flushing in between.
I see nurses just crush and mix all of them. my patient load is getting higher and I really can't do it the "proper" way anymore.
so before I start crushing and mixing everything together in a cup... what medications should I make sure NOT to mix with each other? or does it really matter? I've heard the pharmacy at my place should tell you about medication interactions, but I'm paranoid and don't want to rely 100% on them.
I mix all the meds wiht water in a specimen cup with lots of water (about 3/4 a urine cup full). Then I shake it well, draw into syringe, and shake the syringe again before flushing. I've never had a tube clog in the 6 years I've been doing this. I think the key is plently of water and mixing well, you can't let the "precipitate" settle and try to push it through as a big glob.
There is no problem for a patient in giving all the meds crushed together, the problem occurs when the mixed meds solidify when mixed together in water and pushed in the peg tube.
This tube is the pts life line and normally the patient is weak so another trip to the OR because a nurse is too lazy to do individual pushes is not only negligant but not cost effective
Yes, I understand that the point of not mixing meds is to avoid clogging the line.That was my point. It doesn't have anything (or at least very little) to do with med interactions.
We use Clog Zapper on my floor if a patients tube does get clogged. I haven't been around long enough to see that be used though.
Okay....I might be "lazy" but in LTC if I have 5 or 6 tube feeders in addition to the other 20 patients...there is no way I'm crushing 10 +pills individually. If a pill is one that is difficult to disolve..get it ordered liquid or some other form.
Use warm water and let them sit for a few minutes.
Flush with plenty of water.
Of course with NG tubes you need to be even more carefull (these are vary rarely used in LTC now days)
I mix all the meds wiht water in a specimen cup with lots of water (about 3/4 a urine cup full). Then I shake it well, draw into syringe, and shake the syringe again before flushing. I've never had a tube clog in the 6 years I've been doing this. I think the key is plently of water and mixing well, you can't let the "precipitate" settle and try to push it through as a big glob.
~Jen
I do the same thing you do and I have never clogged a tube. I also flush with pleanty of water. If the med can be liquid I get it ordered that way as well.
Maybe this is not correct, but when I draw up crushed meds in a 60cc syringe, I use 60cc of water, shake up the meds(in the hope that hey dissolve a bit), push them in and then flush with 30cc. I've never had a problem with that.
They really should be disolved before you draw them up in the syringe. Thats part of the clogging problem some of you may see. Never had it happen if you let them sit in the cup first.
so before I start crushing and mixing everything together in a cup... what medications should I make sure NOT to mix with each other? or does it really matter? I've heard the pharmacy at my place should tell you about medication interactions, but I'm paranoid and don't want to rely 100% on them.
thank you. :redpinkhe
about drug interactions: Clinical Drug Therapy by Abrams has a section at the end of each chapter about the drugs the increase or decrease the effects of the drugs in each classification.
For eg. - Drugs for Asthma: some drugs decrease the effects of bronchodilators: phenobarbital because of enzyme induction, it increases the metabolism of theophylline; or propranolol {and other nonselective beta blockers} because they cause bronchoconstriction so they oppose the effects of bronchodilation, or lithium because it may increase excretion of theophylline and therefore decrease therapeutic effectiveness
And the drugs that increase the effects of bronchodilators: erythromycin, cimetidine, or clindamycin because they decrease theophylline clearance so this will increase plasma levels.
or Aminoglycosides & Fluoroquinolones: drugs that decrease the effects of fluoroquinolones are sucralfate, buffered didanosine, antacids, iron preparations, and zinc preparations
or Beta-Lactam Antibacterials: drugs that decrease effects of penicillins such as ascorbic acid, erythromycin, tetracyclines, aminoglycosides; drugs that decrease effects of cephalosporins such as cimetidine, ranitidine, antacids containing aluminum or magnesium (so they must be given 2 hours apart)
This is just a few egs from several chapters. Each chapter has a full list of drug interactions that increase or decrease effectiveness for that drug classification.
Specializes in Nursing Home ,Dementia Care,Neurology..
We are very rarely allowed to crush tablets.If we feel there is a swallowing compromise then we ask for a drug review.Either the tablets are discontinued if it is found they are not now necessary or they are changed to liquid format.
what medications should I make sure NOT to mix with each other? or does it really matter? I've heard the pharmacy at my place should tell you about medication interactions, but I'm paranoid and don't want to rely 100% on them.
thank you. :redpinkhe
another eg of drugs not to be mixed - is metformin and various drug interactions:
furosemide will increase effects of metformin (because it increases blood levels of metformin)
cimetidine will increase effects of metformin (because cimetidine interferes with metabolism and increases blood levels of metformin - so there will be increased risk of hypoglycemia)
And, that increased level of metformin could result in adverse effects:
Specializes in Emergency, Case Management, Informatics.
another eg of drugs not to be mixed...
While your information is useful in a broad sense, it doesn't directly pertain to the procedure of mixing crushed pills for G-tube administration. Mixed meds by G-tube are at no higher risk for interactions than mixed meds by mouth.
oh my god. i sometimes will have like 12 different crushed meds to be given through the G tube. i can not, for the life of me, imagine giving them each separately. lordy that would take all day! i mix them, unless there is a specific order not to.
There is an order in my facility for crushing/mixing meds via G-tube that states "Medications may be crushed and mixed together unless contraindicated." I dont know the rationale behind doing them all seperately but if the state came into the facility for survey you would have to crush each med individually, mix it in its own cup of water. Check placement, flush 30 cc H20 followed by the first med and then flush 10 cc between each med. After all meds are administered in the tube you would again flush 30 cc.
MS._Jen_RN, ASN, RN
348 Posts
I mix all the meds wiht water in a specimen cup with lots of water (about 3/4 a urine cup full). Then I shake it well, draw into syringe, and shake the syringe again before flushing. I've never had a tube clog in the 6 years I've been doing this. I think the key is plently of water and mixing well, you can't let the "precipitate" settle and try to push it through as a big glob.
~Jen