Medications Mixing and Nasogastric Feeding Tubes

[kjeanw]

I have a questions regarding medications and mixing of medications.  When giving multiple medications through a nasogastric feeding tube, you must crush and give separately and flush in between to prevent the medications from interacting with each other.  My question is, is there not a risk of them interacting with each other once they all end up in the stomach together?  Is this just much less likely to interact there, but still a possibility? while the feeding tube would be a guarantee to interact with each other if given together?  Also can uncrushed medications ever be given thru a nasogastric feeding tube, such as enteric coated or sustained release?  Or if they can't be crushed then you simply don't give them and try to find an alternative?

[LovingLife123]

My facility’s policy is to crush them individually, so I do that.  The reason is that mixing crushed meds together is considered compounding medication which is out of our scope of practice.  It’s not about it ending up all in the same place.

Also mixing multiple meds together clogs the tubes.  One of my biggest pet peeves is a feeding tube that is not flushed properly and clogs.  So, I’m a stickler for keeping those feeding tubes flowing properly.

I know people think I’m crazy that I do them individually.  It doesn’t take me a ton of time to do each med individually.  After 9 years, I’m pretty fast.  

[amoLucia]

1 hour ago, LovingLife123 said:

Also mixing multiple meds together clogs the tubes.  One of my biggest pet peeves is a feeding tube that is not flushed properly and clogs.  So, I’m a stickler for keeping those feeding tubes flowing properly.

 

You are a nurse after my own heart!!

Clogged GTs = grrrrrrr!! And you always knew which other nurses didn't flush their GTs.

[LovingLife123]

10 hours ago, amoLucia said:

You are a nurse after my own heart!!

Clogged GTs = grrrrrrr!! And you always knew which other nurses didn't flush their GTs.

Oh you know I do!  

[CalicoKitty, BSN, MSN, RN]

On 4/7/2021 at 11:23 AM, JBMmom said:

I think this is one of the biggest nursing school world vs real world examples out there. Yes, in nursing school (or when the state is observing), medications are crushed separately and administered separately because theoretically, mixing two or more medications can alter the bioavailability or intermediates. I have not seen any publications that can point to specific examples but I guess the problem is you can't always be sure.  Other than not crushing extended release or coated medications, or giving sublingual or buccal medications, almost everyone puts all the meds together with G tube meds. 

 

I just watched a poor student nurse giving the 1 pill at a time crushed to a patient. I had a hard time not looking confused and asking why he wasn't just giving them all at once.. ?

[LibraNurse27, BSN, RN]

I always gave them each separately because my instructor made such a big deal out of it in school! Plus what if the state walks by ?

[0.9%NormalSarah, BSN, RN]

Ain’t nobody got time for that.

[kbrn2002, ADN, RN]

That is a perfect example of what we do in real world nursing vs what we are supposed to do.  In practice the vast majority of us just crush and mix all the meds together, the reality is we are supposed to give each med individually with a flush between meds. The SNF I worked for obtained MD orders for all our feeding tube patients that stated "OK to crush and combine medications for administration unless contraindicated" to get around this new at the time state mandate.  

If you are in a LTC setting I suggest getting these orders from the MD. Otherwise remember to do it the "right" way when State is around or your facility will get dinged.  In an acute setting it may still be worth  getting the order to combine meds to cover yourself if somebody complains about you breaking the rules. We all know there's at least one in every crowd that just loves to run to management and report every little infraction.

[Crystal-Wings, LVN]

Enteric coated pills can never be crushed, and whole pills can never be put in a GT or NG uncrushed. When in doubt, call MD to get the order changed. 

[amoLucia]

2 hours ago, Crystal-Wings said:

Enteric coated pills can never be crushed, and whole pills can never be put in a GT or NG uncrushed. When in doubt, call MD to get the order changed. 

Neither should extended-relief pills.

I do know a RN who attempted to administer a Colace gel tab whole with a GT. And she tried to do it during a State survey med pass inspection. (The surveyor stopped her!) Needless to say we got DINGED!

I never liked to crush together gazillion pills - usually I would just split them out to do half, or maybe a third, at a time.

[MiladyMalarkey, ASN, BSN]

I have never administered them one at a time.

[FashionablyL8, CNA, LPN]

On 4/13/2021 at 2:09 PM, amoLucia said:

 

I do know a RN who attempted to administer a Colace gel tab whole with a GT. 

That's a bit scary!  I'm sure she was very popular with management after that ?. 

[RNfaster]

I keep them separate... Crush, add water, and then give. I also measure out flushes separately. This allows time for meds to dissolve. It really doesn't take that long.

I do like the idea to get an order from provider to crush and combine meds for administration....