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?

[subee, MSN, CRNA]

They taught me some stupid things in nursing school to address non-problems.  Don't want the tube to clog?  Made a dilute solution and wash it down with a flush.  Tube won't clog.  Giving them separately seems like an academic's solution so address what needn't be done.  It makes me cringe when I see quotes from people that that's "what they were taught in nursing school".  Things change!:)

[Kitiger, RN]

34 minutes ago, subee said:

 It makes me cringe when I see quotes from people that that's "what they were taught in nursing school".  Things change!:)

I sometimes say that, but I am eager to learn new stuff!

[londonflo]

On 4/8/2021 at 1:09 PM, amoLucia said:

I think it's just the carbonation fizz that helps.

Many years ago I worked in home health and we had a recommendation to use "Accent", the meat tenderizer in 7 up didn't work.  In those days I don't think there were any plant-based formulas, and just as Accent makes a steak tender by breaking down proteins, the tube would be unclogged if it was formula clogging it. This was long ago and the feeding tubes placement required a CXR so we tried everything to keep the patient home. I am not recommending this now.

[subee, MSN, CRNA]

4 hours ago, londonflo said:

Many years ago I worked in home health and we had a recommendation to use "Accent", the meat tenderizer in 7 up didn't work.  In those days I don't think there were any plant-based formulas, and just as Accent makes a steak tender by breaking down proteins, the tube would be unclogged if it was formula clogging it. This was long ago and the feeding tubes placement required a CXR so we tried everything to keep the patient home. I am not recommending this now.

 

What was the green stuff we used to put in feeding solutions so we would know if the patient aspirated?  Someday people will look at our modern-day practices and bemoan the stupid, primitive things we are doing now:)

[amoLucia]

Food dye? I used blue food dye once; GI doc thought I was pretty smart.

[londonflo]

12 minutes ago, amoLucia said:

Food dye? I used blue food dye

We did that too until the pathologist doing a post complained about the gi tract totally died blue!

[amoLucia]

That lady wasn't imminently deathly - she just sputtered a lot.

But I guess that pathologist would be PO'd.  :))

[amoLucia]

I remember old-timey Accent. But it was a food taste enhancer - monosodium glutamate. A salt that was beaten to death as unhealthy. Didn't know it to be a tenderizer.

[Allgood2016, LPN, LVN]

When I had patients with feeding tubes I would contact the doctor(s) who wrote the orders and request a verbal order for all meds to be in liquid form (if med was available in liquid form). 9 times out of 10 they would agree.

I would write order like this:

All medications in liquid form due to NG tube administration. 

V.O. Dr. Jones/then my signature.

Pharmacy depts. were very cooperative with th order written this way.  If a med didn't come in liquid form; they would make it.

[londonflo]

1 hour ago, amoLucia said:

I remember old-timey Accent. But it was a food taste enhancer - monosodium glutamate.

I thought I read it had papain in it too but a goggle search doesn't show that currently and the recent label says it is a 'food taste enhancer', still has MSG. 

Quote

Pineapple has papain, an enzyme that’s used in commercial tenderising products. Like acids and salt, this enzyme breaks down tough muscle fibers.

I did learn that putting Accent on a dogs food will stop them from eating their own feces...it seems to give an off-putting smell to the stool(?)

[amoLucia]

... learn something new everyday!

[momofm1998]

You guys are awesome!! Some really great hints and methods!! I have seen everyone of these methods done over my years in nursing and they all work. I so agree with doing whatever it takes to keep that ng tube clear. I HATED coming on my shift , breezing down to do my NG feedings and BAP! a clogged tube! Just ruins the whole shift and throws you behind all shift. PS the carbonation works!