Nurse

Harleyhead · Dec 30, 2007

I think the MD orders spells it out. You can give each med one after the other. How would you give them if it were po instead of tube?

withasmilelpn · Dec 30, 2007

Check your facility policy. 5 to 10cc should be enough to dissolve each. 30cc in between each is what you stated and what you should do. I was always taught to do the meds fairly quickly after the in between flush so as to not allow air in. Make sure you check for placement and residual as well. Just rememer they are people too. I'm pleasant and helpful with them, and they have never seemed to give me a hard time. Good luck!

Agnus · Dec 30, 2007

Hi All,
i have to crush all meds in separate med cup (30ml) individually.
how much water should i mix with each med cup?
How long should i wait before pouring second medicine?
how much water shud i pour after each med to flush that medicine in between?

This is a new one on me. What is the practice rational for this. I was taught crush all meds together desolve and administer them together is just fine.

What do you think happens when they all end up in the stomach together desolved? they do not go to separate stomachs they mix together they are all desolved together. Administering them a "few minutes apart" does not change this.

calliesue · Dec 30, 2007

Hey, been through the survey process with state and G tubes. Never had any problems with them. They want to see you follow policy and procedure.

Ours has always been crush and dilute each med individually.

You should ask your facility's staff development nurse for a copy of p&p; and ask her or him to watch you give gtube meds so you get comfortable with an audience.

Also don't forget the basics:

knock on the door, introduce yourself to pt even though they see you every day.

allow for privacy shut curtain and door

only expose as much of body as you need to,

auscultate injected air and aspirate gastric contents.

I always talk out loud to pt while I am doing these things, so the pt hears me and so does the state.

give meds and h2o by gravity don't push unless you have to.

I set up a towel on the bedside table so I have a place to set things down.

Also even though all the meds are going to the same place you can't crush them and mix them unless you have a drs order that says so.

Don't forget to wash your hands and glove up.

Good Luck!

Tait, MSN, RN · Dec 30, 2007

It is funny sometimes over how anal retentive we are after school about some things. Don't take offense, I am just thinking about my first time with g-tube meds in school.

"generally" I would hope:

1) Pharmacy is giving you meds you can crush. If I am not sure I always consult my drug book.

2) They are giving you meds that don't interact with each other. Hence the common timing.

3) In the end (of the tube, heh) its not a chemical lab, or a testing center...its a stomach. Food goes in, meds go in, mash mash mash, down the line. I believe we did g-tube meds separately in school because of learning technique, and not a whole lot more. Giving 10 cups of meds seems to be a tired bit of overkill. And as a previous poster stated a few seconds or minutes between meds is not going to make a difference. If you truly wanted them one at a time you would have to wait about 30 minutes between each one to give it time to exit the stomach etc.

Key points:

-Turn off the wall suction.

-Disconnect

-Check placement (air, contents, pt reaction, pH)

-Flush the tube, 30 mL sounds fine as per your orders.

-Give the meds, and watch your patients reaction for any problems etc (shouldn't happen if you already checked the placement) (gravity for PEG's and push makes sense for g-tubes considering its all kinda uphill first then down, just go slow and monitor your patient)

-Flush with 30 mL.

-Leave suction off and patient upright for 30+ minutes for absorption.

-Go back and hook up suction.

Ta da.

Tait

lil' girl, LPN · Dec 30, 2007

Our facility bans us giving "cocktails". We must give each med on its own, flush, give med, flush. Their reasoning behind this is in case something happens we will know which med was given and stayed "down".

Tait, MSN, RN · Dec 30, 2007

Our facility bans us giving "cocktails". We must give each med on its own flush, give med, flush. Their reasoning behind this is in case something happens we will know which med was given and stayed "down".[/quote']
Logical.

MoopleRN · Dec 30, 2007

The meds do, of course, all wind up together in the stomach so I do see the logic in questioning why can't they be given together. From what I understand, the answer is because some meds may react together in the actual tube itself, forming particles/precipitate that could potentially clot/block the tube (over time) even though you're flushing with your 30 ml in between.

How much water should you mix with each med?

You just want enough to dissolve the med or if it doesn't dissolve right away (some don't), enough for you to draw it up into your syringe.

How long should you wait in between each med?

You don't have to wait because you're flushing with 30 ml at the start of your meds, in between each med, and after the last med.

How much should you give in between?

Look at your order. Flush with 30 ml before and after.

withasmilelpn · Dec 30, 2007

I was taught too, that some meds do react together and will clog or coat the tube eventually.