Pushing meds through NGT/OGT with the plunger

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  1. How do you give meds through the OGT?

    • 26
      I just pour it in.
    • 69
      Use the plunger, I don't have time for this!
    • 17
      Pour, but plunger if it's even a little slow.

29 members have participated

Specializes in Quality, Cardiac Stepdown, MICU.

Had a pt with a husband who wrote EVERYTHING down. (Don't you love those.) Intubated/sedated/OGT. Giving her a med through the OGT like I always have -- take the open syringe, hook it up to the med port, hold it up around chest level, pour in my cup with the med and water, watch it go down, lift up a little if it's going slow, then pour in fresh water to flush.

Husband was floored. "I've never seen anybody do it like that!" he said. "They always push it in with the plunger."

I'll be honest, I've taken care of maybe 25 NGTs in my career before hitting the unit. I always did it this way. Here I've used the plunger once, because it was kinda stuck and my preceptor told me to. I also use it when I check residuals, and to return the residuals. (And for placement checks after inserting.) But I never felt comfortable using it for med administration.

Am I weird/overly cautious? Obviously if the tube's clogged all bets are off, let's get that sucker going. But if it's flowing freely, does anybody else skip the plunger?

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You're not weird, but gravity seems to be a non-acute care thing. It's actually a more gentle, conscientious way to give meds, but for me personally - ain't nobody got time for that. The other thing I don't like is that sometimes the tube will regurgitate and you have few options without a plunger.

Your patient's husband is an inappropriate idiot, by the way.

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Specializes in NICU.

In the NICU where nearly all the patients have NGs, it's very common to have "gravity feeds" where you just hold the syringe full of milk up and let it go down with gravity. For medications, I usually push it in since they're so thick down a little 6 french tube although even then, I try to do it slowly if it's something noxious like sodium chloride or aquadek so that the little ones don't puke. I don't see any contraindication besides the extra time or pushing in a thick fluid that would get clogged...

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Specializes in Quality, Cardiac Stepdown, MICU.
Your patient's husband is an inappropriate idiot, by the way.

He was a little annoying, but a little background: She had open fistulas in her stomach that were leaking fecal contents (long story), and he had been taking care of the dressings at least twice a day or more for years. With crusting (layers of stoma power, skin prep, barrier ointment, repeat x3). Her skin was GORGEOUS despite being in almost constant contact with fecal matter.

So, annoying though he was, he took fantastic care of her at home. And when my husband's hospitalized, I'm *that* family member too, though I don't write stuff down. So I guess I can't really blame him.

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I do gravity, may use "soft push" with plunger if it's clogged.

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Specializes in ICU.

I've only seen gravity used with a G-tube, but it's basically the same thing. No reason it can't be done either way.

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He was a little annoying, but a little background: She had open fistulas in her stomach that were leaking fecal contents (long story), and he had been taking care of the dressings at least twice a day or more for years. With crusting (layers of stoma power, skin prep, barrier ointment, repeat x3). Her skin was GORGEOUS despite being in almost constant contact with fecal matter.

So, annoying though he was, he took fantastic care of her at home. And when my husband's hospitalized, I'm *that* family member too, though I don't write stuff down. So I guess I can't really blame him.

Hovering I can deal with (although I think some of these people need to find something else to do at least part of the day), but the writing everything down I find belittling and kind of harassing.

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Specializes in Quality, Cardiac Stepdown, MICU.
Hovering I can deal with (although I think some of these people need to find something else to do at least part of the day), but the writing everything down I find belittling and kind of harassing.

I didn't see it so much as a litigious, "I'm taking records so I can sue you" kind of thing, but more like "I'm overwhelmed by all this and how long it's gone on, and if I don't take notes I won't remember progresses and setbacks from day to day." I got this from his attitude at the time, not "omg what did you do?" but more like, "Oh, her BP is down today, that's good, let me note the time."

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I didn't see it so much as a litigious, "I'm taking records so I can sue you" kind of thing, but more like "I'm overwhelmed by all this and how long it's gone on, and if I don't take notes I won't remember progresses and setbacks from day to day." I got this from his attitude at the time, not "omg what did you do?" but more like, "Oh, her BP is down today, that's good, let me note the time."

That wouldn't bother me as much, but I still find it extremely bizarre.

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Specializes in Surgery, Trauma, Medicine, Neuro ICU.

I've done it both ways. Depending on how much time I have and if I'm giving a free water bolus as well. Neither is wrong. If I'm giving tube feed boluses which is basically almost never I'll use gravity.

I've also taken the whole notebook writing thing both ways...as the "nervous need to remember things" kind of way AND the "I'm super litigious and going to sue the pants off all of you" way. Depends on the family!!

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For everyday ICU use, I use the plunger. The only time i have used gravity was on a peg tube. The doc ordered bolus tube feed q4, so i used gravity in order to avoid gastric upset. As someone else said, nobody in the icu got time to sit there and watch meds flow down a tube. Get it in quick, and go worry about something more important.

If you like using gravity, keep doing it. Doest matter what everyone else does or what people say. Its probably better for the pt than slamming it in, but then again, maybe not in a culture where people's stomaches are used to multiple big macs being slammed in every day.

Kinda off topic, but has anyone else heard that dr pepper can unclog some NG tubes? A coworker mentioned it to me the other day and I had never heard it before. Obviously would be an off-label use lol..

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For everyday ICU use, I use the plunger. The only time i have used gravity was on a peg tube. The doc ordered bolus tube feed q4, so i used gravity in order to avoid gastric upset. As someone else said, nobody in the icu got time to sit there and watch meds flow down a tube. Get it in quick, and go worry about something more important.

If you like using gravity, keep doing it. Doest matter what everyone else does or what people say. Its probably better for the pt than slamming it in, but then again, maybe not in a culture where people's stomaches are used to multiple big macs being slammed in every day.

Kinda off topic, but has anyone else heard that dr pepper can unclog some NG tubes? A coworker mentioned it to me the other day and I had never heard it before. Obviously would be an off-label use lol..

Cola can sometimes unclog a tube, but it's not best practice and can actually precipitate and make the clog worse.

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