why does liquid med through NG make the pt gag?

Nurses General Nursing

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I was administering med through NG Fr 10. The NG was patent and in the right place; I got 15cc residual, heard air woosh through sthethoscope, the catheter length checked out. The HOB was at least 30 deg.

The pt was fine when I flushed/pushed 50cc water. But she gagged when I let liquid Ranitidine 10cc drain down from the open syringe. The pt thought the medication reflux is causing her to gag. I asked myself, "If so, why didn't she gag when I pushed 50cc of water a minute ago?" After the med, I again flush with 50cc of water by pushing it. The pt is fine. I let the tube feeding run at 80cc/hr. The pt is fine all night. I had the pt for two nights and same thing happened every time.

First of all, why would anything draining down the NG cause one to gag?

Can somebody explain this to me? Thanks

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Specializes in Neuroscience/Brain and Stroke.

I know they can sometimes feel the tube move when you push fluid quickly but that is strange that she didn't do the same with the water.

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You shouldn't be pushing anything through a NG, you allow it to flow by gravity.

The stomach has chemical receptors and can cause a gag reflex when they are irritated.

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Specializes in Neuroscience/Brain and Stroke.

Maybe I was using the wrong term for this, in our hospital the term NG and feeding tubes are used interchangeably even though they are two different things. With our feeding tubes we do push water and meds, tube feedings are ran by pumps, hope that makes sense.

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Maybe I was using the wrong term for this, in our hospital the term NG and feeding tubes are used interchangeably even though they are two different things. With our feeding tubes we do push water and meds, tube feedings are ran by pumps, hope that makes sense.

You never push medications or fluids through any type of feeding tube. You administer by allowing the liquid to flow by gravity. A feeding tube is not an IV.

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A feeding tube is irritating to the gastrointestinal tract. Large or sudden volumes of medication or water can irritate even more causing a gag reflex or reflux. Medications, obviously, are more irritating than water so pushing medications is even worse.

When you eat you do not "push" food down your throat and into your stomach, you allow it drop by gravity.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I agree you shouldn't be "pushing" anything through an NGT. Gentle guidance on the plunger should be enough. (unless of course are "pumping" an OD stomach but that is another situation all together)

That being said........some patients have a huge gag reflex and the manipulation of the tube when nstilling the meds can stimulate the gag reflex...for some it is psychological at watching something "going in that tube".

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Specializes in Neuroscience/Brain and Stroke.
You never push medications or fluids through any type of feeding tube. You administer by allowing the liquid to flow by gravity. A feeding tube is not an IV.

Thank you for this information, I will do a little research on this since this is the way my nursing instructor has taught us. I am in a pediatric hospital now and this is how we were trained to give meds, push 2 ml for a flush, the med, and another 2 ml flush, using gravity has never been discussed but I will follow up with him on this method.

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Specializes in Neuroscience/Brain and Stroke.

Another question if you don't mind. If we use a pump to adminster tube feedings and it's set on say 37ml/hr, this isn't using gravity is it? Is this ok because it is flowing slower than if I were pushing a flush or med?

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Another question if you don't mind. If we use a pump to adminster tube feedings and it's set on say 37ml/hr, this isn't using gravity is it? Is this ok because it is flowing slower than if I were pushing a flush or med?

Lets say you pushed the 50ml over 1 minute, that is a rate of 3,000 ml/hr. Did you even push it that slow?

You are correct in that a pump is not flowing by gravity but the volumes are much lower and the flow is much slower.

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Specializes in Neuroscience/Brain and Stroke.

The largest amount I have pushed through an NG is 8 mls, 4ml for flush and 4 mls of medication, but these are babies so that's a decent amount. The exact directions I received while pushing was it doesn't matter how fast because if he were to take a drink it would all go down all at once, so it didn't matter. I'm not justifying it if it is wrong, just letting you know where the rationale is coming from. But again, thank you for the information and I will ask my instructor about it.

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the largest amount i have pushed through an ng is 8 mls, 4ml for flush and 4 mls of medication, but these are babies so that's a decent amount. the exact directions i received while pushing was it doesn't matter how fast because if he were to take a drink it would all go down all at once, so it didn't matter. i'm not justifying it if it is wrong, just letting you know where the rationale is coming from. but again, thank you for the information and i will ask my instructor about it.

sorry, confused you with the op hence the 50ml. principle stands.

american society for parental and enteral nutrition (aspen) publishes guidelines, along with other groups. these are some excerpts from their guidelines.

"bolus feedings are given via gravity or over a longer period of time via an enteral feeding pump...

at no time should a bolus feeding be given in a shorter period of time than a child would be expected to consume if given a bottle feeding. "

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