Please help review for med admin through g tube

[nrse76]

I work at an LTC (new grad) as an RN and my employer told me they want to "quiz" me on med admin through g tube so they're going to watch me do one.

I believe the patient I have has A LOT of meds through the g-tube, including gabapentin (which is in the fridge).

So with the liquids like gabapentin and keppra, do I also mix them with warm water (just regular warm tap water?)

So, please correct me if any of these steps are wrong.

1) get patient's vitals

2) look at MAR

-go to the fridge first to get gaba

- get a cup of regular, warm tap water

3) look at MAR again and find rest of meds (pop them out of packet without touching them wile making sure its the right dose, time, patient, route, and med)

4) individually crush each pill- how much water do I mix each pill with?

5) keep all meds in separate cups, including liquids

In patient's room:

1) wash hands, get more warm water from tap if needed

2) put on gloves

3)tell patient that I will be giving meds- place towel on patient's stomach

4) look at patient's id bracelet

5) listen to patient's bowel sounds

6) check placement of g tube by putting about 10 cc of air and listening for the swish

7) do I need to check for residuals?

8) start with 30 ml of warm water in syringe, give a med,then 15 cc inbetween each med, and end with 30 mL

A FEW QUESTIONS:

1) what about patient that would need like a 240 ml bolus of water, too. Do I do that before or after giving the medications?

2) Also, or g-tubes, is it okay to push the med through by syringe (it's not by gravity right?

3) do you suck the meds up through the syringe and go back and forth by closing and opening the port

------ or do you take the plunger out, give a med by the top of the syringe, put plunger back in and push the med through, take plunger out, etc. ?

[KelRN215, BSN, RN]

If you're going to give 15 mL of water between each med as well as 30 mL before and after, a significant portion of that 240 mL water bolus is going to be covered. I have never flushed a GT between meds. Does someone who takes oral meds drink 15 mL of water between every med? Of course not.

Also, why would you need to mix a liquid med with water? I can see individually crushing each medication/keeping them separate (though not everyone does that) but not independently crushing each pill. That will take you forever. If you need to give 5 pills to make the patient's dose of one medication, crush them together. How much water you mix each dose with depends on the med. A small tablet like ativan or decadron can be mixed with less than 1 mL but larger pills will need more water.

[heronurse]

I got quizzed last week and dont forget to wipe your bp machine before doing it. Its my only mistake

[nrse76]

Ok, thanks. That is what I meant- keeping each dose separate (like if the patient needs two ativan pills, crush those together but don't crush them with a tylenol too,).

Is using the plunger to push the meds through the g tube via syringe alright (or does it have to be by gravity)?

[Susie2310]

What does your facility policy say about administering meds through G-tubes?

[LadyFree28, BSN, LPN, RN]

Have you reviewed your policy at work?

[heronurse]

If they are quizzing you it should be via gravity, as always as it is.

[KelRN215, BSN, RN]

Ok, thanks. That is what I meant- keeping each dose separate (like if the patient needs two ativan pills, crush those together but don't crush them with a tylenol too,).

Is using the plunger to push the meds through the g tube via syringe alright (or does it have to be by gravity)?

I don't think I have ever, in 9 years of being a nurse, administered GT meds by gravity. We mix them with such a small amount of water in pediatrics and just push them.

[dream'n, BSN, RN]

I remember a thread on here about G-tube administration from maybe a year ago? I remember because of the whole, can't mix meds and all the flushing between drugs surprised me. I specifically remember it because I was never taught that and had never done that in 22 years of nursing. I've always crushed my pills, mixed them in warm water all together, and administered after checking placement and residual. Some patients, especially renal or heart patients would have alot of trouble with so much fluid between each and every pill. But someone posted the actual administration guidelines on that old thread and sure enough flushing was required after each and every med. I recommend searching for the old thread for the standard US guidelines because it is here somewhere.

And I still don't completely get why they want every med given separately, I know it was said that the medications may not combine well, but they're all going to be mixing together in the stomach,

[heronurse]

According to potter and perry funda each drug should be given individually with a 15ml flush after each med but in reality and the way I do it. (I work in ltc too) I learned to mix them all togehter and flush after haha I know this is not the standard of practice but in ltc this will save you time. Even liquids, i mix all liquids together and crushed meds in it then dilute it with water.

[AspiringNurseMW]

I remember a thread on here about G-tube administration from maybe a year ago? I remember because of the whole, can't mix meds and all the flushing between drugs surprised me. I specifically remember it because I was never taught that and had never done that in 22 years of nursing. I've always crushed my pills, mixed them in warm water all together, and administered after checking placement and residual. Some patients, especially renal or heart patients would have alot of trouble with so much fluid between each and every pill. But someone posted the actual administration guidelines on that old thread and sure enough flushing was required after each and every med. I recommend searching for the old thread for the standard US guidelines because it is here somewhere.

And I still don't completely get why they want every med given separately, I know it was said that the medications may not combine well, but they're all going to be mixing together in the stomach,

My lab nursing instructor of 25 years experience would hand me my behind if I EVER mixed meds for g tubes. And always flush in between meds, g tube or iv. One of the rationales was that if pt started having a reaction to meds partly through the administration, you could at least narrow down to which meds it could be vs if you gave them all at once.

[dream'n, BSN, RN]

My lab nursing instructor of 25 years experience would hand me my behind if I EVER mixed meds for g tubes. And always flush in between meds, g tube or iv. One of the rationales was that if pt started having a reaction to meds partly through the administration, you could at least narrow down to which meds it could be vs if you gave them all at once.

I understand it's the standard now, but I personally find it ridiculous. I really doubt that a patient would start to react to a G-tube med as quickly as it would take to flush and add another. These meds are going through the GI tract, not through an IV which is much quicker acting and a reaction may be seen very quickly.