Meds and a G-T patient

Posted
by buggybum96 (New) New

Correct me if I'm wrong....please! As an LPN graduate from the class of 2008, did someone, somewhere change the administration of medication concept for a g-tube patient? Today, I was informed by a much older "experienced" LPN that we "are not supposed to give medications via gravity to a GT patient." They are supposed to be given bolus via syringe even though the Plan of Care does not specifically indicate this. I've been administering all meds via gravity with flushes. And just to clarify...I really do know the correct method of using gravity to administer all prescribed medications (liquid and crushable meds). I just couldn't believe this was told to me.

Am I crazy?

Edited by buggybum96

guest114

51 Posts

The way your "supposed" to do it is dissolve EACH individual med separately in a med cup, flush the tube (you need the syringe to administer the meds) then do each med separately with a small flush in between, then flush at the end. Always allow gravity to do the work. If there's s clog you can always manipulate the tube with your hands, there's all kinds of tricks. Some people will use lotion or Vaseline on gloved hands and massage the tube to loosen any clogs, others will use gingerale. A bolus is just like a feeding from a can all at once, like Jevity or something, instead of getting the feeding over hours via a pump, your still allowing gravity to to the work. You just never want to push with a plunger. And always listen for placement! People never do but it really takes two seconds..

OhioCCRN, MSN, NP

Specializes in SICU. Has 11 years experience. 572 Posts

*reality* crush everything / dissolve in water/ pour down the tube with a healthy flush.

PacoUSA, BSN, RN

Specializes in ICU / PCU / Telemetry. Has 10 years experience. 3,445 Posts

Hope you're not crushing extended release tabs. Get those changed to liquid or crushable forms.

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buggybum96

9 Posts

Thank you so much. I know I'm not crazy but had a much older nurse tell me that we're not supposed to use gravity. I said "not in the school I attended and graduated with honors at. Just had to shake me head at the comment.

buggybum96

9 Posts

All meds are liquid and/or crushable. It's method we are discussing. :)

guest114

51 Posts

Usually when it's a GTube patient the md only orders crushable or liquid forms but def let them know to change if it's not ....but always gravity as far as method goes.

PacoUSA, BSN, RN

Specializes in ICU / PCU / Telemetry. Has 10 years experience. 3,445 Posts

Occasionally you'll have a physician forget the route and orders SR, the nurse needs to be diligent about watching for this. Continue discussing the method 😊

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JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 12 years experience. 1 Article; 13,949 Posts

In nursing school during med pass we had to crush medications. Four classmates went before me and all crushed extended release potassium. I asked the nurse if there was a liquid or crushable form in the formulary. Not one classmate questioned the "MUST SWALLOW WHOLE DO NOT CRUSH" on the package and pharmacy label. Fortunately routine labs were drawn and she was fine.

We don't do gravity with my pediatric clients. The drugs are liquid, compounded by pharmacy, or dissolvable in water. We use one syringe per medication and give one at a time flushing at the end (most are smaller children and can't handle the extra volume of flush between drugs). So we do small volume "GT push" rather than "GT gravity".

buggybum96

9 Posts

JustBeachyNurse....I certainly understand that fact. My pt is 12 with no fluid restrictions and 10-30 mL before/between/after meds. She gets a max of 40mL water for one med pass. No worries here on volume overload. I certainly understand its patient specific on volume but my question was really just asking about the method of administration. I just got tickled that this was being told to me. Have done gravity for years unless specified. :)

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 12 years experience. 1 Article; 13,949 Posts

None of my patients are gravity. But that doesn't mean gravity is wrong. Most of my kiddos are small volumes so syringe push in these cases is more efficient and less drug lost. Several of my clients cannot handle fluid over 30mL or bolus feeds instead they are 50-70mL/hr continuous.

Gravity is proper in many patients.

vampiregirl, BSN, RN

Specializes in Hospice. Has 12 years experience. 1 Article; 749 Posts

*reality* crush everything / dissolve in water/ pour down the tube with a healthy flush.

Depending where you work and what medications are being administered, it may be acceptable to obtain a physician's order to allow medications to be mixed w/ a specified pre and post flush. This was a huge time saver for me when I worked LTC.

Knowing which meds cannot be crushed is critical. Here's a link for a resource that we've used a two places I've worked that did not have lists in the P&P manual: http://www.ismp.org/tools/donotcrush.pdf

There are also a few funky meds, PPIs come to mind, that require specific techniques to administer via g-tube.

If someone tells me that something is supposed be done in a specific manner not specified in a plan of care, I always ask them for their reference. I approach it as an opportunity to learn. Sometimes they cannot provide a reference in the P&P manual or other appropriate resource (which means I'm going to continue doing something the way I understand as being correct), other times I get to learn something cool. There have even been a few times when I've been able to get our P&P manual amended or updated to current EBP.