How to give meds through PEG tube?

[howmanypeaches]

Hello all. I’m a new nurse. How do I give meds through a PEG tube? There’s only one port/opening for feeds/meds and no clamp. I’ve been crushing meds and mixing it with sterile water to fill a 30mL syringe, flushing with 30mL before/after/in between med administrations.  Is this correct? Also, sometimes I only have 1mL of liquid medication to give (Tylenol or oxycodone, for example) that I mix with sterile water (at least 15mL). Is it OK to be mixing the small, prescribed amount of liquid meds with that much sterile water? Do you ever use a smaller syringe than 30mL? I assume anything smaller would be too much pressure? Thanks a bunch!!

Edit: also, what’s the best way to get air out of the syringe? I find it harder to accurately get air out by pushing on plunger (with the tip up) without a little bit of liquid getting out. please help!

[Rose_Queen, BSN, MSN, RN]

Have you checked your facility’s policies and procedures for guidance? If you are unable to find guidance there, what about your preceptor, educator, or manager? Pharmacy may be another resource. Please be aware that you will be expected to follow your facility’s expectations, so they are the best place to start. 

[JKL33]

On 7/19/2021 at 7:45 AM, howmanypeaches said:

Edit: also, what’s the best way to get air out of the syringe? I find it harder to accurately get air out by pushing on plunger (with the tip up) without a little bit of liquid getting out. please help!

Let's see...

I'll start with what does make liquid shoot all over: Holding the syringe in typical tip-up 3-point fashion (thumb on plunger, index finger on left flange, middle finger on right flange) and just pushing on the plunger with the thumb. Not enough control.

Instead I hold the filled syringe in the palm of my hand such that the flange portion of the barrel of the syringe is about at the center of my palm, then use the top part of my hand and thumb to grasp the barrel while using the lower edge of my palm/fingers to squeeze/push up on the plunger portion. As a two-hand alternative you could hold the syringe the same way (which results in the palm gripping both the barrel and plunger portion) and then using other hand to push plunger. The hand/palm holding the syringe does so in a way to provide just enough resistance to counteract abrupt plunger movement.

Sorry so many words; difficult to describe.

Oh, obviously stop when liquid coming toward the end of the tip. Small amount of air OK.

[summertx]

On 7/19/2021 at 6:45 AM, howmanypeaches said:

Also, sometimes I only have 1mL of liquid medication to give (Tylenol or oxycodone, for example) that I mix with sterile water (at least 15mL). Is it OK to be mixing the small, prescribed amount of liquid meds with that much sterile water?

We only have piston syringes. Even if the syringe is 60ml, I never mix pain medication with that much liquid. Maybe 5mls, but if it's diluted too much, they might not get the full therapeutic effect.