question about giving meds thru PEJ tube

[Lola77]

When you give meds thru a pt's PEJ do you crush the meds separately and put them into individual med cups, mix with water and administer each separately followed by a flush? I have always just thrown them all together, mixed with a little warm water to help them dissolve, then add about 20 CC water and administer them all together followed by a flush. I started to do this the other day at my new job and a nurse told me that I had to do them separately.

How do you administer meds thru a PEJ? What about a regular PEG?

Thank you for the input - I am a fresh nurse (6 mos) and still learning learning learning. . .

[WSU_Ally_RN, BSN, RN]

It all depends on what your facilities Policy and Procedure's say... the hospital where I work, our policy is to give each separate with a flush before, after, and in between each... Does each nurse do it this way, probably not, but I've always been told, if I do something "my way" and it's not policy, and something happens to my pt, it's my butt on the line... if I followed policy and something happened, then the hospital will stick up for me.

[Forever Sunshine, ASN, RN]

I don't have time to do it that way. I am not sure about J-tube as I have never had a patient with one yet. Only PEG tubes.

I crush them up and mix them together with warm water. I flush 50ccs of water before and after giving the meds.

[Asystole RN]

The by-the-book way is to administer separately so as to avoid med interactions.

Meds are just chemicals, crushing and mixing unknown chemicals together can make unknown results.

[carluvscats]

I always had to do them separately when I worked pediatric home health, partially because it was important to be vigilant about keeping track of my client's H2O intake (each med had a certain amount to dissolve and a certain amount to flush...the amount of water used in the night feeding depended on how much we had used during the day for meds). And, some meds just don't dissolve that well ~ it was best to keep them separate to avoid clogging issues.

I do believe it is the "by-the-book" way to do them, as Asystole said.

[chenoaspirit, ASN, RN]

They all get mixed together in the stomach when swallowed anyway... :shrug:

I mean, they get all mixed up when taken

[Asystole RN]

They all get mixed together in the stomach when swallowed anyway... :shrug:

I mean, they get all mixed up when taken

Too bad they aren't going into the stomache...

Think about this.

When giving IV medication why do we have to hang so many seperate piggybacks? Why not just mix everything into one bag and infuse...its all going into the same blood right?

When you crush meds and dilute into a fluid you create a solution not unlike an IV med, except this solution is being infused into the jejunum.

[MoopleRN]

I crush and flush each med separately because I was taught to do so/my hospital cg say to. It's a matter of not having the meds causing precipitate in the tube. It's not about they all get mixed up in the stomach anyhoo, it's about keeping the tubing patent. It also helps keep them hydrated with the extra flushes. So I was taught, so I do, so my clinical guidelines say.

[caliotter3]

I was taught to do them separately to keep the tube patent and to prevent confusion should part of the concoction be inadvertently spilled or some other mishap. If you do it separately, you will know which meds "made it" and which need to be prepared again.

[kids]

I was taught to do them separately to keep the tube patent and to prevent confusion should part of the concoction be inadvertently spilled or some other mishap. If you do it separately, you will know which meds "made it" and which need to be prepared again.

This. And it reduces the chance of interactions within the syringe.

It's the way I was taught 20 years ago, has been the P&P every place I've worked and is an expectation of the State surveyors.

I don't find that it adds much time to the admin.

[fromtheseaRN, BSN, RN]

I was taught to do them separately to keep the tube patent and to prevent confusion should part of the concoction be inadvertently spilled or some other mishap. If you do it separately, you will know which meds "made it" and which need to be prepared again.

this is exactly what i've learned so far in school, and what i do in my clinicals. also, i've seen one nurse mix them all and then administer, the tube clogged, and we had to send the pt off to get a new tube. if you do each one separately and flush between, your chances of clogging the tube will diminish greatly.

[netglow, ASN, RN]

I was taught to do them separately in school as well, but in clinical the nurses all combined meds. The interaction thing to me is neither here nor there as all are entering together. If you think you are giving meds via tube separately to avoid interaction, you'd have to wait quite some time inbetween each med.

The trouble here that would make me think twice, is that if you say get a clog or a blow-out when you've instilled part of your combined solution, you would have no way of knowing what got in and what didn't. So, you get to figure out whether or not your beta blocker was one of the meds that got in.... or not.... then what do you do, risk over or underdose? As soon as I think of it that way I want to do each drug individually.