Protonix beads for g-tube

[sistrmoon]

We have new little packets of protonix beads specifically for g-tubes. The med instructions say to draw up with apple juice and flush with apple juice until clear. That's what I did but it still clogged the tube:( My coworker says she always uses warm water. What do you do?

[Loo17]

The Protonix particles are activated at neutral pHs, like water, and the low pH of applesauce/juice allows them to safely make it into the stomach.

For patients who have a nasogastric tube or gastrostomy tube in place, PROTONIX For Delayed-Release Oral Suspension can be given as follows:

* Remove the plunger from the barrel of a 2-ounce (60 mL) catheter-tip syringe. Discard the plunger.

* Connect the catheter tip of the syringe to a 16 French (or larger) tube.

* Hold the syringe attached to the tubing as high as possible while giving PROTONIX For Delayed-Release Oral Suspension to prevent any bending of the tubing.

* Empty the contents of the packet into the barrel of the syringe.

* Add 10 mL (2 teaspoonfuls) of apple juice and gently tap and/or shake the barrel of the

syringe to help rinse the syringe and tube. Repeat at least twice more using the same amount of apple juice (10 mL or 2 teaspoonfuls) each

time.

No granules should remain in the syringe

[KelRN215, BSN, RN]

sistrmoon said:

And I did flush again with water after the apple juice but not warm. I'm not sure where my coworker is getting warm water as we aren't supposed to use tap for consumption. The coffee/tea station?

Why aren't you supposed to use tap water for consumption? People drink tap water and the gut is not a sterile environment. Unless the patient is immunocompromised and instructed to only drink bottled water, there's no reason why tap water can't be used via GT. When I worked in the hospital, they re-did our GT policies stating that we had to use sterile water for all GTs, had to scrub the GT ports with alcohol prior to accessing with syringes or feed bags and then less than a year later revoked all these changes because they realized there's no evidence to support this.

To the topic at hand, you can give applesauce via GT. But protonix also comes in an oral suspension that's easily administered via GT, why not just ask the provider for that?

[JustBeachyNurse, LPN]

The only patients that I've had requiring sterile or boiled water are brand new GT post op and reduced immunity or immune deficiency. Most use bottled water because it's easier to keep a bottle of water with the meds and feeding supplies. The fresh post op GT with severe reflux the sterile water was for aspiration risk but that was debunked as the water was no longer sterile and likely had a lower pH after being in the stomach for a period of time. We use sterile water to inflate the GT/GB balloons though.

Unless the tap water is not potable or contaminated (if it's contaminated it's likely not safe for hand washing either) there is little to no reason to NOT use tap water.

[Karou]

sistrmoon said:

And I did flush again with water after the apple juice but not warm. I'm not sure where my coworker is getting warm water as we aren't supposed to use tap for consumption. The coffee/tea station?

Does your facility have a policy for not using tap water? What is their rationale?

I am curious because in the different settings I have worked (LTC, rehab, medsurg hospital), I have only used tap water. The gut isn't sterile so I don't see why you wouldn't be able to use tap. I also use warm because it aids in the medication dissolving.

I agree with a PP that the only time I could see tap being contradicted is if the patient is immunocompromised and/or with a new tube. In that case I assume it would be clearly ordered that they need sterile water only.

As for the protonix beads, I second (third?) agitating the syringe. I love the described "tornado" method! I have never thought of it like that, but that's what I do. Many times in the hospital we end up doing protonix IV though, which avoids the clogging risk.

[sistrmoon, BSN, RN]

KelRN215 said:

Why aren't you supposed to use tap water for consumption? People drink tap water and the gut is not a sterile environment. Unless the patient is immunocompromised and instructed to only drink bottled water, there's no reason why tap water can't be used via GT. When I worked in the hospital, they re-did our GT policies stating that we had to use sterile water for all GTs, had to scrub the GT ports with alcohol prior to accessing with syringes or feed bags and then less than a year later revoked all these changes because they realized there's no evidence to support this.

To the topic at hand, you can give applesauce via GT. But protonix also comes in an oral suspension that's easily administered via GT, why not just ask the provider for that?

At my hospital specifically, we are not to use the tap water for consumption. I believe we had contamination with Legionnaires?

[caliotter3]

The doctor can order a compounded suspension form. The problem here is that it must come from a compounding pharmacy and a pharmacy that does not like to deal with this will tell you that the compounded form is not covered under medicaid. Strange, because other pharmacies do not say this, they just provide the med.

[KelRN215, BSN, RN]

caliotter3 said:

The doctor can order a compounded suspension form. The problem here is that it must come from a compounding pharmacy and a pharmacy that does not like to deal with this will tell you that the compounded form is not covered under medicaid. Strange, because other pharmacies do not say this, they just provide the med.

Or the MD didn't do the paperwork for the prior auth necessary for some compounded meds. I know compounded omeprazole requires a prior auth from Medicaid in my state but the pills don't.

[OneDuckyRN]

I wasn't aware Protonix came in a suspension/bead form. We use Nexium (esomeprazole) for our PEG/J tubes and we don't use apple juice to mix it. Just warm water, let it sit for a few minutes, and flush, flush, flush! It does cause clogging problems for Dobhoff/Tiger tubes, but for the larger bore tubes, it's not such a problem.

[KelRN215, BSN, RN]

OneDuckyRN said:

I wasn't aware Protonix came in a suspension/bead form. We use Nexium (esomeprazole) for our PEG/J tubes and we don't use apple juice to mix it. Just warm water, let it sit for a few minutes, and flush, flush, flush! It does cause clogging problems for Dobhoff/Tiger tubes, but for the larger bore tubes, it's not such a problem.

Prilosec and Prevacid do too. I see liquid Prilosec all the time, liquid Protonix sometimes, liquid Prevacid rarely and have never seen Nexium in liquid or compounded forms. That's just because Nexium doesn't tend to be prescribed for children though, at least not in my neck of the woods.