GTube, med administration..HELP

leslie :-D · Jul 27, 2004

I am looking for some info on med administration through G tubes. I have seen some nurses administer meds by gravity (which takes a long time, even with dilute meds) and others use gentle push with bulb or syringe. What's the nursing standard? If "pushing" with syringe, what's the best way to draw up to avoid the instillation of air and pt distention? Also on G tubes, what is the standard for aspirating, measuring and documenting residual. Some say only if ordered, some say q4.
If you have info or a good website regarding this, I would love it.
Thanks!!!

we didn't have any orders to check residual but it was checked q shift just as good nursing measure. typically any residual over 1/2 of hourly fdg is held. if it's only 10-50 ccc, no big deal. the only time air should purposely be instilled is to confirm placement of g tube, and then 5-10cc/air is enough.

as for instilling meds, some go in quickly and others need a gentle push, but again, avoid pushing in air. make sure the plunger goes down to where the diluted meds are, with no air inbetween. and always flush with water.

Long Term Care Columnist / Guide · Jul 27, 2004

I am looking for some info on med administration through G tubes. I have seen some nurses administer meds by gravity (which takes a long time, even with dilute meds) and others use gentle push with bulb or syringe. What's the nursing standard? If "pushing" with syringe, what's the best way to draw up to avoid the instillation of air and pt distention? Also on G tubes, what is the standard for aspirating, measuring and documenting residual. Some say only if ordered, some say q4.
If you have info or a good website regarding this, I would love it.
Thanks!!!

I've always pushed meds through a syringe after crushing very finely, and then flushing the tube with an appropriate amount of water (at least 60mL). Of course, you'll want to aspirate to check residual before giving meds/feedings; as a rule you'll check it Q 4 hours minimum. With small-bore tubes, gravity takes forever, and nobody has that much time......still, you don't want to push in a bunch of air and make the patient uncomfortable. What I do is mix up the medication in water or juice, then draw it up into the syringe and push it in gently, then flush again with another 60mL of water. If additional water is ordered, I give that too, of course. And if the tube gets clogged, I've often used soda pop to clear the obstruction (diet soda if the pt is diabetic).....it's old wisdom, and some of the 'experts' tend to pooh-pooh it, but in a pinch it's pretty reliable!

leslie :-D · Jul 27, 2004

if it's a new gtube, or a postop gi pt., then yes, residual should be checked q4h.....but you might want to check with the md for those with gtubes for a long time. or check your p&p.

if you pinch the tube with the 60cc syringe connected at the tip, you can just pour it in and take the plunger, gently push it forward w/o pushing in air. just a tiny push will propel the diluent down.

and yes, what marla said about tonic for breaking obstxn.

LTC_LPN · Jul 27, 2004

As a LTC nurse, I always check for placement before I do anything else. When giving meds through a g-tube, I crush the med powder fine, then mix with a little water (unless it's contraindicated). For liquids, I'll give them as-is, then follow up with the flush as ordered...usually 60 or 120 cc water. The best way to give the meds is by gravity, but we all know that some of these tubes just DON"T cooperate that way...you can stand there for 30 minutes and the syringe is still full! So a gentle push is all that's needed. I'm a firm believer in properly flushing these tubes....if one is ever found stopped up when I come on duty, it's a write up. Period. If flushed correctly and as ordered, they should never become stopped up. And I've un-stopped some whoppers in my time!:angryfire :angryfire :angryfire

Edit: Also, I never intentionally push air into a resident. Although I've read of other nurses "unstopping" tubes by forcefully pushing air through the tube...which ends up giving the res a painful case of gas! And I've heard of nurses using soda pop to unstop tubes, too. Our facility uses de-cloggers but only as a last resort. I have save many from an unnecessary trip to the hosp for tube replacement because I was able to unclog the tubing. What's bad is when the lazy nurse sends the res to the ER with a stopped up tube and the ER flushes it and sends them right back...and the family gets the ambulance & hosp bill for $$$ and demands to know what happened...while the Er staff is laughing at us for being "those idiots at the nursing home"....

leslie :-D · Jul 27, 2004

What's bad is when the lazy nurse sends the res to the ER with a stopped up tube and the ER flushes it and sends them right back...and the family gets the ambulance & hosp bill for $$$ and demands to know what happened...while the Er staff is laughing at us for being "those idiots at the nursing home"....

or worse, when a gtube comes out and no one puts a foley in to keep the stoma open, waiting for the other gtube to be delivered.

that burns me, as the stoma closes up within a couple of hours and the patient has to have another surgical procedure.... :angryfire

barefootlady, ADN, RN · Jul 27, 2004

I always check for placement prior to giving meds. I flush with 10 to 15 cc water prior to giving meds, just to check if tube is slow running, give meds, flush with water, no less than 60 cc and then recap. I find that most nurses do not do routine tube care, just a little soap and water around the insert site goes a long way. I will give a gentle push if meds are too slow running but I really like to allow gravity to do the job. Most doctors here do not mind if a extra 100cc of water is given during a shift. Water is essential to life but we often get too busy to remember the tube patient needs it just as much as we do, especially during summertime. I always elevate the patients head too. Who eats or drinks laying flat?

VA_CCRC · Jul 27, 2004

As a general rule ALWAYS make sure the head of bed is elevated before administering in a GT.

I usually make sure that the meds are ordered as suspensions or elixirs if available.

ALWAYS dilute meds down with warm water. NEVER juice or cola. Juices and colas have sticky sugars that over time WILL adhere to the inside of the tubing and eventually clog.

That's my 2 cents!

Take care all!! :rotfl:

Gampopa · Jul 30, 2004

In clinicals this past week I have a pt with a new J-tube. One nurse I was orking with said to instil some air and auscultate before giving anything to verify tube placement but why would you do this with a J-tube that's surgically placed?

leslie :-D · Jul 30, 2004

In clinicals this past week I have a pt with a new J-tube. One nurse I was orking with said to instil some air and auscultate before giving anything to verify tube placement but why would you do this with a J-tube that's surgically placed?

1. all you need is 5-10cc of air to confirm placement.

2. tubes can migrate, albeit less common in the jejunum. but you would not want it migrating to the duodenum or ileum.

zacarias, ASN, RN · Jul 31, 2004

1. all you need is 5-10cc of air to confirm placement.
2. tubes can migrate, albeit less common in the jejunum. but you would not want it migrating to the duodenum or ileum.

I was just thinking, who's to say you can hear bubbles (gurgling) when the tube is in the duodenum. Plus if a J-tube and G-tube, insufflating air in both will make that sound.

I did research a a year or two ago and basically is said that the auscultation method wasn't really that great or based on research but's it is so common place and what we do as nurses because that's what we have.

In the instance of an NG feeding tube, we do an X-ray but only after insertion. It's not practical or economical to do an X-ray every single time we're going to insert something into the tube. pH testing is an option and while it's not on the market yet, bilirubin testing will be useful. Of course these aren't in the policy and procedure manual I'm sure. Still there are cases where NG tubes have gotten into the lungs giving a nasty pneumonia or causing death.

leslie :-D · Jul 31, 2004

I was just thinking, who's to say you can hear bubbles (gurgling) when the tube is in the duodenum. Plus if a J-tube and G-tube, insufflating air in both will make that sound.
I did research a a year or two ago and basically is said that the auscultation method wasn't really that great or based on research but's it is so common place and what we do as nurses because that's what we have.
In the instance of an NG feeding tube, we do an X-ray but only after insertion. It's not practical or economical to do an X-ray every single time we're going to insert something into the tube. pH testing is an option and while it's not on the market yet, bilirubin testing will be useful. Of course these aren't in the policy and procedure manual I'm sure. Still there are cases where NG tubes have gotten into the lungs giving a nasty pneumonia or causing death.

hi zac,

i don't listen for gurgles but the 'whoosh' sound of air.

and yes, pH is definitely tested to match gastric acidity.

and i wouldn't instill anything into an ng tube unless i was completely confident it was in the abdomen.

and i'm not certain on what you're asking regarding ja nd g tubes. yes both would make the same sound but would be auscultated in anatomically different locations. am i understanding your question correctly?

leslie