NG tube question-please help!

Nurses General Nursing

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Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

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Specializes in ER, ICU, Infusion, peds, informatics.

it really depends on why the pt has an ngt.

in general, the tube is there for feeding or for decompression of the stomach.

if it is for feeding, it may be due to the pt being unable to take nutrition by mouth (comatose, swallowing problem, etc), or unable/unwilling to take enough nutrition by mouth. in the first case, you would have to give the meds via ngt. it would not be safe to give the meds by mouth. there may or may not be an "npo" order, but a critically thinking rn or lpn will know not to give the meds by mouth in that type of patient. the reason i say there might not be an npo order in this case is that in some institutions, to dietary, "npo" means not to release any feedings at all, including tube feedings. this pt's diet order might read "jevity at 70 cc/hr," even though they are technically npo.

in the second case, i personally would let the pt decide how to take the meds -- by mouth or per tube, if the pt was able to make the decision. if they were uncooperative, i would probably give them via tube and not think twice about it. i seriously doubt the doctor would care which route the med got into the patient, as long as it got there in a timely fashion.

as for the pt with the ngt that is decompressing the stomach, if they have po meds ordered and are able to swallow them, i give them a choice as to how they want to take the meds. of course, the tube then needs to be clamped for about 30 min after the med is given, regardless of whether or not the pt actually swallowed the med or not.

the exception would be if it was some med that would not be safe to crush (sustained release, etc). then you would have to get the pt to swallow the med or get an alternative dosage form to put down the tube. this is really the only time i would agree with the write-up, unless that hospital had some policy that had been violated.

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Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

Better yet, why was the pt even ordered a pill if he had an NG. THAT order should have been clarified before giving it, p.o. or via NG

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Specializes in ER, ICU, Infusion, peds, informatics.
better yet, why was the pt even ordered a pill if he had an ng. that order should have been clarified before giving it, p.o. or via ng

actually, there are legitamate reasons why a patient would have both an ngt and have pills ordered.

they could be just getting supplemental feeds per ngt, say post-op or for whatever reason just are not consuming enough calories by mouth to meat their nutritional needs. not really common, but it does happen.

if the ngt is for decompression, they may be in the process of weaning the pt from the ngt, seeing if they tolerate it being clamped.

or, they may have meds that just don't come in any other form, but the pt really needs them. psych meds come to mind. in that case, the tube can be clamped afterwards. true, depending on what is wrong, they may not be absorbed very well, but they should get some.

Up Vote Up Vote ×
Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

Where was this clinical instructor when the student was giving meds unsupervised? I think a med error write up is harsh. Maybe the instructor should write themself up for NOT being supportive enough or available.

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actually, there are legitamate reasons why a patient would have both an ngt and have pills ordered.

they could be just getting supplemental feeds per ngt, say post-op or for whatever reason just are not consuming enough calories by mouth to meat their nutritional needs. not really common, but it does happen.

if the ngt is for decompression, they may be in the process of weaning the pt from the ngt, seeing if they tolerate it being clamped.

or, they may have meds that just don't come in any other form, but the pt really needs them. psych meds come to mind. in that case, the tube can be clamped afterwards. true, depending on what is wrong, they may not be absorbed very well, but they should get some.

i understand this now, thanks so much for your help! one last question--why did you say the tube would have to be clamped for 3 0mintes regarldess of wheather or not they take the pill byt mouth?

thanks again :)

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Specializes in ER, ICU, Infusion, peds, informatics.
i understand this now, thanks so much for your help! one last question--why did you say the tube would have to be clamped for 3 0mintes regarldess of wheather or not they take the pill byt mouth?

thanks again :)

because if the ngt is to suction, then the suction will suck the med right back out. you need to give the stomach time to absorb the med before you reconnect the suction.

(only applies if the ngt is for decompression of the stomach. if it is for feeding, you would only have to clamp the tube if it had to be given on an empty stomach -- like dilantin. in that case, you would hold the tube feeds for probably 1-2 hrs before and 30-60 min after giving the med)

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Specializes in ICUs, Tele, etc..
Hey everyone:

One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.

I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?

Thanks so much:)

that's a little harsh, i mean unless someone crushes a sustained release med and flushed it thru the ngt, that instructor is way too much

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because if the ngt is to suction, then the suction will suck the med right back out. you need to give the stomach time to absorb the med before you reconnect the suction.

(only applies if the ngt is for decompression of the stomach. if it is for feeding, you would only have to clamp the tube if it had to be given on an empty stomach -- like dilantin. in that case, you would hold the tube feeds for probably 1-2 hrs before and 30-60 min after giving the med)

thanks again! you are so wonderful in your explaining! you should become a clinical instructor or nursing professor if you aren't already!

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Hey Y'all

Critterluvr gave great answers!!! (And the Instructor not only was wrong to call this a med error, she missed a wonderful opportunity to TEACH!! I'll 'write her up' for an 'Instruction error'!!)

Maybe I'm out of line to jump in when CL is answering your question, but---why clamp the NG Tube for 30 mi? Because (first) most of those tube are routinely connected to suction and you don't wanna suck the med right out of the pt. And if it's not connected to SUCTION but is just to 'bedside drainage'--you have added fluid to the stomach side of the tube and increased the pressure there so its going to migrate up the tube, even if you don't see it. Clamp the NGT to keep the med in the tummy.

Papaw John

Oops--conversation was going on while I was typing away---I'd delete this except for my remark about 'instruction error'.

PJ

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Hey Y'all

Critterluvr gave great answers!!! (And the Instructor not only was wrong to call this a med error, she missed a wonderful opportunity to TEACH!! I'll 'write her up' for an 'Instruction error'!!)

Maybe I'm out of line to jump in when CL is answering your question, but---why clamp the NG Tube for 30 mi? Because (first) most of those tube are routinely connected to suction and you don't wanna suck the med right out of the pt. And if it's not connected to SUCTION but is just to 'bedside drainage'--you have added fluid to the stomach side of the tube and increased the pressure there so its going to migrate up the tube, even if you don't see it. Clamp the NGT to keep the med in the tummy.

Papaw John

Oops--conversation was going on while I was typing away---I'd delete this except for my remark about 'instruction error'.

PJ

no, thank you too papaw for the explanation....I am really thankful when people post to my questions :)

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ngs are used to relieve gastric distension b removing gas, gastric secretions, or to instill medication, food, fluids, or to obtain a specimen for lab analysis. the tube may be used post-op when the person is able to digest food but not eat it, or it can be left in place for tube feedings until the ability to eat normally is restored.

medications can be given through the ng, usually the doctor will order med by that route: via ng. there are meds that are available in liquid form, like tylenol or reglan, if possible try to obtain an order for a liquid form of medication if available. when instilling meds via ng you should flush with 30ml sterile water pre and post-medication administration. do not mix meds together for administration, each med should be administered separately and followed with a 30ml flush. ngs need to be clamped 30 minutes after medications are administered to allow for absorption of the medication.

you can give meds orally with ngs if it is not contraindicated (pt unable to swallow). you still need to clamp the ng for 30 minutes after administration. if there is no reason the person cannot swallow, i encourage patients to take pills orally, the only problem i will have is if "the other nurse" gave it through the ng :uhoh3: i will give the medication through the ng if that is what the patient wants, however if the medication is enteric coated or capsule i will not and will explain to the patient why. ng can be very irritating to the patient and even more so if the patient has difficulty swallowing pills to start with.

enteric-coated medications should not be crushed, the enteric coating combats the effects of stomach juices, which can interact with or destroy certain drugs. also with capsules they should not be "opened" to administer through the ng either, they may be "time-released", meaning they are meant to be digested further along the gi tract. if swallowing is definately contraindicated, check with pharmacy about capsules and enteric coated medication prior to administration.

as a student nurse, whenever possible check what the facilities policies are regarding ng (or anything else) and if possible make a copy of it for future reference when you are at that facility. unfortunately there are nurses who do not always follow policies and procedures. in situations like that, when i was a student the excuse "the nurse told me to do it that way" was not acceptable. whenever as a student if orders are not clear (as may be the case in this situaiton) discuss it with your instructor. research the medication prior to administration via ng, an excellent example is about the dilantin and tube feedings that critterlover posted.

the instructor could have written the person up for:

1. not clarifying route of administration with the physician. route should be part of every medication order, one of the 5 rights of medication administration. our pharmacy are sticklers for route. from you post it sound like this was the instructors issue. although the staff should have verified route when they got the order, that does not relieve staff (or in this instance nursing student) that follows for not verifying route with the physician. with any sbon, "nobody else verified the order/route" will not be accepted as a valid excuse.

2. not knowing policies and procedures for medication administration via ng. although she may have been instructed properly by the rn, the fact that she didn't research policies and procedures may not have sat well with the instructor.

3. if she mixed medications, the instructor would be correct for writing her up.

4. if any of the medications were enteric coated or capsules, that too could constitute a medication error.

5. if the ng was not clamped after medication administration, that also would constitute a med error.

when i was a nursing student, i had instructors who would have had kittens if i didn't know policy and procedure or know the pharmokenetics of medications.

good luck with school sweetie715.

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