Crushing meds individually?

OgopogoLPN, LPN, RN · Sep 25, 2008

I also was never told about crushing meds individually for a G tube. A classmate of mine mentioned this to me a few weeks ago as the facility she works at has this protocol.

When a resident can swallow, many will swallow all the pills at once. Or when you crush them in applesauce or pudding, they're all crushed together. It doesn't make much sense to crush them indiv and flush for a G tube.

If anyone has any literature on this, I'd love to read it and become better informed. :nurse:

txredheadnurse, BSN, RN · Sep 25, 2008

The rationale given to me for crushing individually and flushing afterwards was that some meds can plug the g tube if combined with certain other meds. Or that some meds by themselves can quickly swell after being crushed and mixed with water so you want to push them quickly thru the g tube.

OK, here is my real world experience. Yep, those things can happen. You know what? It happens if the meds are crushed and given together po (that is form a plug) or can still plug a g tube if an insufficient flush is not given after them. 10 or 15 cc of water is not always enough to push a quickly swelling substance the entire length of the g tube into the stomach.

Having been in a facility where more than half of our residents had g tubes I witnessed/experienced these issues and also had my staff telling me that there was no possible way they could crush individually an average of 7-9 meds per client for 20 clients and get done in the allowed time frame. I agreed. I went to the GI docs and our pharmacy and asked why, what can we do, etc.

Turns out the majority of those incompatible meds can be replaced by a compatible combination and that the biggest culprits for plugging the g tubes were things like protonix and prilosec. Why? they both have micro encapsulated beads which are not intended to be ruptured mechanically and swell like sponges whenever the contents are mixed with liquids! I experienced this one night trying to just open the prilosec and give it solo. Not being a juggler I had a period of time of oh, say 20-30 seconds after I opened the capsule and mixed it with water before I could draw it up in the syringe. In that incredibly short period of time the stuff had not only more than doubled in size it became as hard as a rock!!

To finish this off let me say look at finding replacement meds for things that form clumps if crushed or mixed with liquids if giving meds via g tube. I say this because other than the reasons I have listed I honestly can't see why g tube meds should be given individually since we don't do that with intact or crushed po meds.

Off soapbox now. :twocents:

loriangel14, RN · Sep 25, 2008

I agree with you on the flush amount. Anytime I have had a pt with a g-tube the docs flush order was always 100cc or more.Sometimes as much as 150.

TheCommuter, BSN, RN · Sep 25, 2008

Now if state is in house, CRUSH THEM SUCKERS ONE AT A TIME or they will GET YOU.....

I agree. You must always do things by the book whenever a state surveyor is observing you. You must always do things by the book when a full-book state survey is being done on the facility where you're employed.

MsLady06 · Sep 28, 2008

Hello! I am an LVN student, tonight in clinicals we had a substitute teacher. She said that the right way to give g-tube meds is to crush each one individually, then give each one individually, flushing with water between each one. We've been crushing all of the meds together for 6 months and have not been told this before. I was surprised because our regular teachers have us do everything by the book! How do you working LVN/LPN's give your g-tube meds? Thanks!
Hummingbird

Your instructor is correct in doing it this way. Some teachers like to do it together to save time. When you hit the real world there will be nurses crushing them altogether but only do it the correct way when the state is there. Some meds you have to give seperately.. some supplements can be really pasty.

Valerie Salva, BSN, RN · Sep 28, 2008

I have always given all g-tube meds together- including pills, capsules, elixirs, poweders, etc.

I put all the meds together (after crushing tabs) in a sterile urine specimen container, add some warm water, apply the lid and shake. After giving the meds, I rinse and dry the cup, and put it back in the med cart to use for the next pt.

It works well, and I've never clogged a g-tube.