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?
Specializes in Critical Care, Emergency Medicine, Flight.
Ok, so someone said that fluid had to be given thru these tubes via gravity? What about the 30ml flush before and after giving meds via NG tube? I've always squished the piston down... Have I been taught wrong?
Specializes in Early Intervention, Nsg. Education.
Undiluted, high-osmolality meds cause retching and cramping. For a list of the osmolalities of common liquid meds, see Table 3 in the attached article. Try diluting with water and give over a longer period of time. If the pt continues to retch, it might be worth trying the IV form given via the NG so that you can take the sorbitol out of the equation. I can speak from experience: I'm the owner of a high-maintenance, low-functioning GI tract "accessorized" with a J for trophic feeds and a couple "enteral-only" meds, a G to continuous gravity drain, and a tunneled CVL for PN and meds. :barf01:
I work on a GI surg floor. A standard order for an NG tube is to flush with 30cc H2O q4 hr. We disconnect from sxn, use a 60cc toomey syringe and slowly "push" in the water, and reconnect.Standard order for J tube feeds is usually the same - 30cc water q4 to keep tube patent. I don't understand the comments never pushing and only using gravity, never heard this before.
The difference I'm talking about is the feeding tubes are the small little tubes used only for intake, the NG's I'm used to seeing in the adult world are large and also used for gastric decompression. With the feeding tubes we use with babies there is no need for more than a 2ml flush due to the size of the tube, more than enough to completely flush the tube.
I think some posters must be envisioning a different scenario than others ... when administering meds or other solutions (CT contrast comes to mind for me ...) there is indeed "pushing" involved.
The presence of the NG is certainly irritating, and the sudden infusion of some substance can be irritating as well, particularly if it is cold.
As for the OP's question of why a patient would experience gagging/irritation upon the administration of one particular med ... I don't have an answer for that.
FORTHELOVEOF!!!!
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Yea I did kind of hijack their thread, sorry about that OP.