NGT medications

DavidFR, BSN, MSN, RN · Jun 26, 2021

I personally do administer them together and have never had a problem. I'm on multiple meds myself. They're in my hand together, I pop them in my mouth together and I swallow them down together. Same principle I reckon.

I have seen some people on here suggest that there might be an interaction like with IV meds. That seems wholly unlikely to me. I discussed this with a pharmacist where I work and he agreed that it's OK to mix for NG administration.

LovingLife123 · Jun 26, 2021

It’s our hospital policy to do them separate. It’s considered compounding meds if you do them together according to our pharmacist. Which is out of our scope. I do them separate. I hate clogged feeding tubes as well. People always ask me how long it takes me to administer meds. I say really no time at all. My meds are passed and I’m almost always charted by 1000.

43 minutes ago, DavidFR said:

I personally do administer them together and have never had a problem. I'm on multiple meds myself. They're in my hand together, I pop them in my mouth together and I swallow them down together. Same principle I reckon.

I have seen some people on here suggest that there might be an interaction like with IV meds. That seems wholly unlikely to me. I discussed this with a pharmacist where I work and he agreed that it's OK to mix for NG administration.

There are definite incompatibilities with IV meds. You always check that. It’s not about them all going in the stomach. It’s about compounding meds when you crush and mix them together. Your pharmacist is wrong.

DavidFR, BSN, MSN, RN · Jun 26, 2021

4 minutes ago, LovingLife123 said:

It’s our hospital policy to do them separate. It’s considered compounding meds if you do them together according to our pharmacist. Which is out of our scope. I do them separate. I hate clogged feeding tubes as well. People always ask me how long it takes me to administer meds. I say really no time at all. My meds are passed and I’m almost always charted by 1000.

There are definite incompatibilities with IV meds. You always check that. It’s not about them all going in the stomach. It’s about compounding meds when you crush and mix them together. Your pharmacist is wrong.

Can you enlighten me as to which meds are incompatible and what actually happens? Apart from drugs which must be taken at a distance orally in any case where you'd respect the same time delay, I can't see it.

I've worked in many hospitals in 2 different countries and never come across a single NG administration policy anywhere. 33 years of passing multiple meds via NGs and never a problem. I know how to flush NG tubes and I've never clogged one.

There is NO comparison with IV administration.

MunoRN, RN · Jun 26, 2021

3 hours ago, LovingLife123 said:

It’s our hospital policy to do them separate. It’s considered compounding meds if you do them together according to our pharmacist. Which is out of our scope. I do them separate. I hate clogged feeding tubes as well. People always ask me how long it takes me to administer meds. I say really no time at all. My meds are passed and I’m almost always charted by 1000.

There are definite incompatibilities with IV meds. You always check that. It’s not about them all going in the stomach. It’s about compounding meds when you crush and mix them together. Your pharmacist is wrong.

A patient ingesting two pills at the same time is absolutely not "compounding" medications, that's possibly the stupidest thing I've heard any supposed 'professional' suggest on this site, so congratulations on that.

JKL33 · Jun 27, 2021

The pharmacists....

Quote

Improper administration. Compatibility of multiple drugs administered together can also be a problem, particularly if two or more drugs are crushed and mixed before administration. Mixing two or more drugs, whether solid or liquid forms, creates a brand-new, unknown entity with an unpredictable mechanism of release and bioavailability. Proper flushing of the tube before, between, and after each drug can help avoid problems.

https://www.pharmacytoday.org/article/S1042-0991(16)30715-0/fulltext

I've never been cautioned about this by anyone IRL/in person, though.

They make this reckless "compounding" sound like those stories of people taking a handful of unknown pills out of a bowl at a party, as if no one has any idea what they're getting or what could happen. ?

LovingLife123 · Jun 27, 2021

21 hours ago, MunoRN said:

A patient ingesting two pills at the same time is absolutely not "compounding" medications, that's possibly the stupidest thing I've heard any supposed 'professional' suggest on this site, so congratulations on that.

It’s not about ingesting them, but thank you for calling my comment the stupidest thing. When you crush the pills then put them in one container and mix them up, it’s considered compounding a medication. I didn’t make this up. I’m not a pharmacist but my unit pharmacist also told me this after I asked when doing the training. It is a policy in my hospital, and this is how it is explained. I don’t make the rules. I simply follow what I have to do education on every single year.

TheMoonisMyLantern, LPN, RN · Jun 29, 2021

In LTC the regulations actually require medications to be given individually through a PEG tube, which is absolute lunacy. Whether it's compounding or not I can't say either way. But the rationale given to nurses for this is often due to possible "interactions" and effecting the patency of the tube.

Maybe we wouldn't have to worry about as many possible "interactions" if providers didn't overload our patients with 20 pills to take a day each one prescribed by a different specialist who only cares about the part of the body they specialize in and not the patient as a whole. But that's a thread for a different day

As far as tube patency, as long as medications are coming in the appropriate form, being crushed very fine, and being administered with and flushed with plenty of H2O there really should be no issues with patency, even with NGT.