Dobhoff med administration conundrum

[Careuhhline]

This is something that has been bothering me for a week. I'm fairly new at a new hospital on a surgical floor. My pt with a dobhoff feeding tube receiving continuous tube feeding had oral medications and it was taking forever for him to take his medication especially lactulose. The CNA said everyone else had been giving the medication via the tubing. So I stopped the feeding, prepared everything, crushed the meds. Found the 60 cc catheter tip syringe already in the room, and come to see there is no way this syringe fits this small-bore feeding tube connection. I tried troubleshooting the problem, tried to place the piece that dangles from the side of the y connection onto the other part hoping maybe that is designed to be a connector and hopefully not a clamp. Was not really successful in any attempt, and in the end gave the meds orally as best I could... Was there a connector I needed to find, or did I need to use a completely different syringe? Our unit does not have a leur lock feeding syringe in our med room.

[Rose_Queen, BSN, MSN, RN]

Have you reached out to the other nurses on your floor? They will be most familiar with the equipment and supplies available. A review of facility policy and procedure may provide guidance as well, such as whether the practice is permitted and required steps

[RNNPICU, BSN, RN]

I would not take the word of the CNA. What did the other Nurses on the unit say. What did the orders say? Sometimes the order may have specific instructions on how much to dilute the medications or if to mix with formula.

[CharleeFoxtrot, BSN, RN]

4 hours ago, Rose_Queen said:

Have you reached out to the other nurses on your floor? They will be most familiar with the equipment and supplies available. A review of facility policy and procedure may provide guidance as well, such as whether the practice is permitted and required steps

This. And if you are to give meds through a Dobhoff be sure you get some advice as those tubes clog up if you aren't super careful.

[LovingLife123]

There should be a connector called a Lopez valve. That’s how you push meds through those.

[mrf0609]

If the patient had a feeding tube due to aspiration issues, then the po route would have been highly inappropriate and could cause significant issues. Most of the time people who have a feeding tube have one due to their inability to swallow for whatever reason. You do not mention why they had the tube but giving meds po when they have a feeding tube is also wrong. Asking for assistance, when you do not know, is very important and will prevent patient injury. If you do not feel comfortable asking a coworker, ask the charge nurse as that is what they are for.

[K+MgSO4, BSN]

Is it an ENfit connection? ENfit is the international entral nutrition standard. It has proven reduced clinical errors with a connection via a specific syringe design. This design cannot be connected to an IV due to the reverse leur lock, thus removing the risk of enteral feed / meds being administered IV. A catheter tip will not connect to it either without a step transfer device.

However, more importantly you should of checked why this pt was being fed entetally either a swallowing issue or he may of had a gastric outlet obstruction and the tube may of been an NJ i.e. sitting in his jejunum. And to be quite honest just because your unit does not have the correct syringe is not a good enough excuse if it was needed, source it and speak to your manager about getting them ordered.

[maybecaturday, BSN, RN]

Hi! You see that little blue cap piece on the one end? It’s actually open and it’s an adapter so you can fit piston syringes on the end! Somehow most of our nurses miss that as well, and use lure lock IV syringes, since we only stock 3-10mL oral syringes (HUGE risk for error and totally don’t recommend that).

[Wuzzie]

You also need to know where the end of the tube is. Some medications are meant to dissolve in the stomach and be absorbed in the duodenum so giving them via an NJ tube is incorrect.

[Careuhhline]

On 12/16/2019 at 6:01 PM, mrf0609 said:

If the patient had a feeding tube due to aspiration issues, then the po route would have been highly inappropriate and could cause significant issues. Most of the time people who have a feeding tube have one due to their inability to swallow for whatever reason. You do not mention why they had the tube but giving meds po when they have a feeding tube is also wrong. Asking for assistance, when you do not know, is very important and will prevent patient injury. If you do not feel comfortable asking a coworker, ask the charge nurse as that is what they are for.

I can clarify, this patient had hepatorenal syndrome. The dobhoff was placed, extending to the jejunum, so that he could receive continuous tube feeds due to poor oral intake. He did not have a problem swallowing.. I think maybe in retrospect I regretted not asking my co-workers which is why I’m reaching out to a larger nursing community for input. I appreciate the insight.