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.
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:
I agree. Always check placment w/ 5cc air bolus before doing anything.
Here is a trick that has helped me. Pour your crushed meds, and some warm water into a sterile urine specimin cup with lid and *SHAKE* to disolve g-tube meds. They usually go in faster, and by gravity, without using the plunger this way. Flush g-tube w/ clear water afterwards. Wash and dry the specimin cup after each use, and keep it in your med cart. Get a new cup peridiocally.
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.
leslie
Leslie,
I actually meant "whoosh" although for some reason I called it "gurgles." :)
pH paper is great to test acidity but a tube that's lower than the stomach will show a higher pH just like being in the lungs would. That's where the bilirubin testing would come in. High bilirubin would be indicative of intestinal placement and low/none would mean it's probably in the lungs. That would be the ultimate in verification.
I actually meant "whoosh" although for some reason I called it "gurgles." :)
pH paper is great to test acidity but a tube that's lower than the stomach will show a higher pH just like being in the lungs would. That's where the bilirubin testing would come in. High bilirubin would be indicative of intestinal placement and low/none would mean it's probably in the lungs. That would be the ultimate in verification.
zach,
i DO vaguely remember being taught 'something' ( ) about instilling blue dye and aspirating it out; and that if you didn't get a return, then it was in the lungs........this i believe was to confirm ng tube placement. sound familiar???
i DO vaguely remember being taught 'something' ( ) about instilling blue dye and aspirating it out; and that if you didn't get a return, then it was in the lungs........this i believe was to confirm ng tube placement. sound familiar???
That does sound familiar and I think that was standard practice maybe up to two years ago?
I have never checked for placement in a g-tube, have always been told, even by the doc's, there is nowhere else for it to go but out?but always use gravity first then gentle push
I have never checked for placement in a g-tube, have always been told, even by the doc's, there is nowhere else for it to go but out?but always use gravity first then gentle push
wow... :imbar that's a first for me. i would hate to think that it has migrated up towards your esophagus.
i've also encountered those tubes that form adhesions which can also muffle any air instilled. you're not just checking placement, but patency.
There is not a whole lot of easily accessed info out there on this topic, as I tried hard to find it several years ago.
What I would suggest, is that you contact the manufacturers of the tubes you use, ie the maker of the J-tube, or the feeding pumps (Ross has excellent literature), and ask them for the product handouts. That is where you will find your evidence-based information. In practice, you may find many people do it differently. Going to the source or company reps ensures you are doing it the proper way.
Now if you're in LTC there is a bunch of procedures you have to do "by the book" HOB up , check for placement (air) flush, administer meds, flush with 5-10cc in between each med. Flush with water before and after. Don't even think of mixing two meds together.
some meds do better if they are dissolved in water without being crushed. in fact they will just float if they've been crushed, but will be quite dissolved if simply placed in water first. you'll quickly find which is which.
some meds do better if they are dissolved in water without being crushed. in fact they will just float if they've been crushed, but will be quite dissolved if simply placed in water first. you'll quickly find which is which.
that's when you have to add applesauce.
i hate those meds that either float or stick to the side of the cup.
another nurse taught me the applesauce trick and it works like a gem.
) about instilling blue dye and aspirating it out; and that if you didn't get a return, then it was in the lungs........this i believe was to confirm ng tube placement. sound familiar???
Hellllllo Nurse, BSN, RN
2 Articles; 3,563 Posts
I agree. Always check placment w/ 5cc air bolus before doing anything.
Here is a trick that has helped me. Pour your crushed meds, and some warm water into a sterile urine specimin cup with lid and *SHAKE* to disolve g-tube meds. They usually go in faster, and by gravity, without using the plunger this way. Flush g-tube w/ clear water afterwards. Wash and dry the specimin cup after each use, and keep it in your med cart. Get a new cup peridiocally.