Meds in Tube Feed bags

mrsbrittLPN · Jul 1, 2008

That is just wrong,wrong,wrong,...Your friend needs to report this nurse immediatly and request that she not shadow her/him during her orientation anymore. It's a shame how some nurses that have been in this field for a longer time become lazy, uncaring people who now become responsible for training new nurses and do a bad job. Let your friend know that placing meds in the tube feed bag is not proper procedure for any institution.(She can also request a coy of her institutions policy and procedure book regarding meds/pt patients medication administration. The feeding should have been stopped, water bolus to tube(amount depending on patient orders,usually 30cc), meds individually crushed/dissolved with water, individually placed down tube with 30cc of water in between each med and 30cc after all meds done,before feeding re-connected and started. Again, the amount of water is dependant apon the patient allowed intake and or policy and procedure for that institiution but I have always seen between 15-30cc standard. I hope this helps your friend..Tell her to not be afraid to ask questions if she feels like she is seeing something done incorrectly on purpose. And let her know that it is also her reponsibility as a licensed professional to report this person, or she can be equally to blame if something where to happen.. :no:

Pediatric Critical Care Columnist · Jul 1, 2008

No this is NOT usual practice anywhere and it definitely shouldn't be, for the reasons already stated. The only meds that should ever be mixed into the feeds are electrolytes like sodium chloride and potassium chloride, and perhaps one or two of the CF meds that are supposed to go in the feeds.

To the second poster... this is a peds patient. That volume of flush might constitute the kid's whole day's fluid requirements if they've got a lot of GT meds to be given... and they often do. A more usual volume of flush would be 5 mls to clear the tube, 5 mls between meds and 10 mls at the end of the med administration. So much depends on the volume of the tube. And the meds are likely in liquid or suspension form already.

This needs to be written up. So what if she's the charge nurse? The fact is that this kid isn't getting his meds in the right dose (some clings to the bag and if someone comes along and hangs fresh feeds, the rest of whatever med that was in there is now gonzo), the right time (what good are most p.o. meds if given over several hours?) or the right rate. This charge nurse needs to take a medication administration refresher! Here she could be reported to our BON and have sanctions on her license for doing that.

mrsbrittLPN · Jul 1, 2008

:yeah:You are right, janfrn, but as I stated amount is dependant upon patients allowed daily intake.

dorie43rn · Jul 1, 2008

I'm glad to hear it is not a regular practice with peds nurses. I told my friend that if something happens to the child, she would be equally responsible since she is the primary nurse. I actually don't like the practice of someone else giving my meds for the very reason that is going on. I even grit my teeth when student nurses are around, because some teachers don't practice the five rights anymore.

wanttobeanavynurse · Jul 3, 2008

Only the CN can give meds? That sounds very odd....

As for meds in the tube feeds, that's pretty much a no-no. Some meds can be mixed with feeds, and is usually ordered by the MDs to be given that way (i.e. lactobacillus). Some meds don't get absorbed as well when mixed with feeds. Other meds react when mixed with feeds - don't mix Miralax with certain formulas unless you want a thick glob of formula!! The original poster is certainly correct in the timing of medication administration...it could be hours until that kid gets the full dose. That could lead to major problems if that med was a heart or seizure med.

There is always someone higher up than the CN. Utilize your chain of command. You could even fill out an incident or event report to help change practice.

deanaRN · Jul 5, 2008

If our kids are being fed via a button we stop feed, disconnect at the button, use a slip tip to give med, then reconnect to the feeds. If it is an NG, stop feed, flush w 5ml, then med, flush w 5ml,restart feed.

rbs105, ADN, MSN, RN · Jul 7, 2008

Well this is kind of funny. See, I am dorie43rn's friend who this happened to. I don't think she even knows I am on this website-I didn't know she was! I just happened to be browsing in peds and saw the topic and thought, "oh, this happened to someone else too!" and read the message to realize it was her and she was talking about me.

First of all, I will clarify and update. This is a pediatric rehab setting, so it is more laid back from an acute care environment. So yes, only the charge RN gives meds. She does not get a pt assignment (usually), but will do all the orders and meds and other charge roles. That practice, I'm told, is soon changing. I am glad because I don't like someone else giving my meds.

Secondly, this nurse has worked there for 20 years and I am brand new. No excuse, but difficult to get others to believe you when you are the new nurse (been an RN for 2 years, but new to peds) and this is the problem I am finding. I have not gotten much of a reaction from my "reporting" of this incident.

Now you will all write back and say I should quit, this is outrageous, i will lose my license, etc. I have been trying to figure out if there is a way to complain like a parent would complain because maybe that would have more weight. It is kind of like, well, we'll watch her. I am trying to find someone there I can trust that will take me seriously and not just be like, oh you're trying to get her fired. OBVIOUSLY it is wrong. That was never my question. It was more of a-how do I go about reporting this and getting them to believe me or do anything about it-question. This is very frustrating because I would not want this woman to take care of my kid.

Anyway, I am sure everyone will be very critical of this, but I was mainly hoping for suggestions from my friend when I emailed her, but it has been interesting to read your opinions (and criticisms) but that hopefully clarifies it somewhat!

rbs105

DDRN4me · Jul 7, 2008

rbs..I dont think anyone here is criticizing your friend the OP..however; she did ask for advice and you wont get much better than AN!!!

i have worked in peds and pedi rehab for more than 20 yrs and would NEVER think of putting meds in a running tube feeding. it is what has been said, poor nursing practice.

what you have seen here are suggestions to help improve your situation. sitting back and waiting because things might change could have a serious impact on a child's health.

good luck; hope this works out for the children'ssake!

JadedCPN, BSN, RN · Aug 4, 2008

Agree with just about all of the above posters. Will use about 5mL, and will only mix with feeds if thats what the particular drug calls for and in that situation I make sure the feeding bag has very little formula in it so that it will not take hours and hours to all get in. The only other time I've experienced a situation was when the patient had a tube for years, and it was mom's home routine to mix meds with feeds, in which I made sure I educated and documented.