Which is correct method admin meds via GT

Tiwi · Feb 17, 2007

As I understand it, the medication port should be used, but it should be flushed pre and post administration to avoid mixing with medications. Of course there are some medications which require the feed to be stopped for a while pre and post. Where I work we do this with Dilantin for an hour each way.

student456 · Feb 17, 2007

i work for a woman that has lou gehrigs disease...i am a 2nd yr nursing student and this is what i do when i have to admin meds via a G Tube

i crush the meds up and then mix it with water in the syringe. Then i disconnect the kangaroo pump from the g tube and flush it with water before giving the meds

then i push the meds slowly just to make sure there are no clogs in the tube....then afterwards i flush with a bit of water again to make sure its clear. i do all of this through the main line, not the other one since i was told this can clog more easily?

RNfromMN, BSN, RN · Feb 17, 2007

We actually had a big debate about this last year...here's what I remember:

Textbooks said to stop feeding & flush with 30 ccs NS/H20 before each medication...wait-sorry our debate was whether or not to flush in between each med. Well, in either case, I think the same theory still applies. So, book said to stop feeding & flush with 30ccs before giving med & to crush each pill separetely & flush with 30ccs between each pill...& after the last one. Instructors all agreed that flushing before medications was unnecessary & not done in the real world, but to respond "textbook style" if it were to ever come up on NCLEX or one of their exams.

It makes sense to me to stop the feeding & flush before giving meds cuz formulas are usually pretty sticky stuff...I'd be afraid little tiny bits of medication would adhere to the tubing & never really reach the pt. Plus, you really don't know how the meds are going to react with the formula, do you? (really, I don't know)...I don't know...maybe I'm stoo-pid:smackingf, but I just don't like the idea a room temperature, milk-based formula mixing with medications...

DDRN4me · Feb 17, 2007

Which port you use is really not important. The reason for the smaller port is so you dont have to disconnect hte entire feeding and add potential bacteria to the semi-closed system. You should definitely stop the feeding and flush both before and after the meds. You could ask to have some of the 250 bolus at that time and hold the feeding for an hour or so to give the meds time to digest. Just a thought.. also depends on the pts planned fluid intake.

burn out · Feb 17, 2007

I guess there is text book and there is real world. If I was giving these pills orally they would all be given at the same time and would all end up in the stomach at the same time I see no difference with giving then via a G-tube.

I always check residuel before I give anything through a g-tube then having crushed all the pills (make sure you have not crushed any extended release pills) I dilute them in water and when as disssolved as much as possible I give them through the feeding port. The little side port is used only for liquid medicine at our facility that is how the docs like it. After giving the med in the feeding port I flush again with 30cc saline and hook the feeding back up. So far I have had no problems with this method and neither has any of my patients.

CritterLover, BSN, RN · Feb 17, 2007

as i understand it, the medication port should be used, but it should be flushed pre and post administration to avoid mixing with medications. of course there are some medications which require the feed to be stopped for a while pre and post. where i work we do this with dilantin for an hour each way.

just wanted to remind everyone -- the feeding and all meds will mix together in the stomach, even if you stop the feeding, give each crushed pill separately, and flush between meds.

[color=#483d8b]the reason you stop the feedings is so that the tf doesn't leak out of the med port when you uncap it.

[color=#483d8b]the reason textbooks tell you to crush each med/give each med separately is in case something happens to the meds -- say you spill some -- you will know what the patient did/didn't get. a huge waste of time in my opinion, though.

[color=#483d8b]as far a flushing between each med, some patients can't tolerate that much fluid. (think about the patients that tend to have fluid restrictions -- renal pts, chf pts -- they often have the most meds. they can't handle all that fluid)

[color=#483d8b]of course, as stated above, there are some meds (like dilantin) that can't mix with tf, other meds, and must be given on an empty stomach. then the tf need to be held before/after admin, and nothing is given with those meds.

[color=#483d8b]kashia, i really don't think there is anything horribly wrong with the way either one of you are giving the meds. there can be different ways to do things where neither is right or wrong, just different. while disconnecting the tf, as you do, may open the system up to outside germs, the gi tract isn't sterile, and you are already doing this when you introduce non-sterile meds through a non-sterile syringe. just make sure the end of the tf tubing doesn't hit the ground while disconnected :wink2: also, remember that the med port doesn't open into a smaller tube, but is just a smaller opening to the single, large tube.

[color=#483d8b]personally, on the occasions i now have to admin meds through a gtube, i put the tf on hold, crush/mix all of the meds together and admin through the side port of the gtube via gravity, then flush with aprox 60cc of water, assuming the pt can tolerate the fluid. then i restart the tf. unless, of course, i'm giving a med that has to be given on an empty stomach. (working in the er/outpatient infusion as i now do, i rarely admin meds through a gtube. however, i used to work in icu, and did it all the time there)

adrienurse, LPN · Feb 17, 2007

My understanding is that the meds in the syringe should not be pushed but the plunger needs to be taken off the syringe and then be allowed to infuse into the port via gravity.

charebec65 · Feb 17, 2007

I work predominantly with one patient, a patient who is on a lot of meds via either GT or JT. Liquid meds get drawn up in separate syringes but I crush all pills together. If that med time includes caps, I mix the contents with the crushed meds. Typically put a little water into the syringe, add some of the crushed med mixture then a little more water and shake it up. I repeat this depending on the amount of meds there are at that time. I do draw up water in each syringe and put it in the JT/GT after putting in the meds to make sure it all ends up in the patient.

After everything is prepared, I put the Kangaroo on hold and use the side port so as not to add any more 'buggies' than unavoidable. Considering during my shift I give meds to this patient 8 times I certainly can't do them all separately or await gravity to do its work, especially at 9am when I give 11 meds (different types) and at 3pm when there are 5. There are only two circumstances where I turn off the kangaroo for a bit. I check placement and residual but don't flush before, only after. I do fold over the upper part of the tubing to clamp it off and keep the meds from backing up into it.

GardenDove · Feb 17, 2007

I would disconnect the tube feeding, attach the syringe, check for residual, flush with a little water, adminster liquid meds one by one first, then administer all crushed meds together mixed in water, then flush, then start up the feeding. Sometimes everything can go in by gravity, sometimes not.

Rabid Badger, BSN, RN · Feb 17, 2007

My understanding is that the meds in the syringe should not be pushed but the plunger needs to be taken off the syringe and then be allowed to infuse into the port via gravity.

I stopped giving meds gravity after I clogged an NG and nearly lost a SBFT. The problem was when you pop the plunger off and dump the meds into the syringe to give gravity, sometimes it chunks and blocks either the syringe or NG. So I mix each with water, draw them up and administer push individually, with a flush in between. May not be how its supposed to be done by textbook, but I was trained to be evidence based, and my personal experience points to gravity method not being NG and frustration safe. At least if I draw them up into the syringe, I know the meds can pass through a smaller bore than the tube itself, thereby bypassing clogging the tube.

nursenikki928 · Feb 18, 2007

I would disconnect the tube feeding, attach the syringe, check for residual, flush with a little water, adminster liquid meds one by one first, then administer all crushed meds together mixed in water, then flush, then start up the feeding. Sometimes everything can go in by gravity, sometimes not.

This is how we do it at my facility also. We are supposed to give each med one at a time but most nurses "cocktail" the meds and just give them all together to save time. All of our T.F. patients have orders to flush with 30cc of h2o before and after each med unles they can not tolerate the fluids for some reason.