question on tube feeding and flushes

[Oranges3420]

I am confused as to the proper way to administer meds and water flushes via gt or ngt. Most nurses seem to flush them in the tubes with the syringe plunger - either due to time constraints or because the fluids/meds don't seem to go down the tube.

Are we supposed to do all of this by gravity?

Is a "water flush" supposed to actually be flushed/pushed in or done by gravity?

Why wouldn't the med/flush go down?

What happens if we flush meds/water with the plunger?

And lastly: I was told in nursing school to flush each med separately but I was shown in orientation to just mix 'em all up and flush them in all at the same time.

What is the RIGHT way to do this? I don't want to do my patients wrong!

[AMCNurse]

I always flush with water, mix my crushed medications (all together unless it's a lot) in a med cup, administer that and then flush again with water to make sure it gets down the tube and doesn't get stuck in the tube. Hope that helps.

[ann4997]

In my hospital we use gravity unless it is in the orders that you can use a "gentle push." It goes fast enough. With the plunger assembled you check for residual, then disassemble it and leave the syringe in place as you pour your water flush, your meds and final flush.

You are right, that in nursing school we are taught to crush each med and admnister separately. Just as when you cursh meds and administer them orally -- you are supposed to give each one separately because once they are crushed you don't know which is which anymore and if for whatever reason if you weren't to give the whole amount how do you know how much of what med was administered.

I too crush my meds and mix them (as was shown to me on orientation) unless there are a lot, then I set up a few in separate med cups. I administer the syups last to make sure they get flushed completely and so none of the crushed meds stick to it (had that happen before and had to use extra water to clear it out).

Anyway, I hope this makes sense and I hope it helps.

[smurfynursey]

I do peds and we are a different world from adult m/s but...here goes.

as far as mixing the meds, it depends. Where I used to work my kids got an ave of 6-10 meds with each pass and they were not unit dose. For that, we mixed it all together. Where I am now, we have unit dose meds and i like it sooooooooooooooooo much better. but thats a side note :)

As far as how meds are given, gravity vs. pushed, we were supposed to do gravity, but for various reasons ended up pushing (slowly) alot of times. also, you can push a little and then take the plunger out to do it by gravity, breaks up any little clogs that would be an issue otherwise.

For pushing the water flush and/or meds (or not) again, it depends on the patient.

I worked at a special needs camp in college, we were told to treat the tube like a fork. Dont push anything faster than you would want it squirted in your mouth.

Hope that helps a bit.

[I<3H2O, BSN, RN]

Every nurse I have ever known has mixed all the meds together in one cup and given them. I believe our hospital policy says to give each one separately. We sometimes have pts on 20+ meds. Can you imagine 30cc of H2O surrounding each med in such a short period of time. I would imagine that would leave the pt. feeling bloated/nauseated. I have never seen a nurse use a plunger to force meds/water.

[karmyk]

I've seen nurses use the plunger to administer the meds... they always tell me they feel like they have more control over the medication and can stop it if they want to..

..I've always done it by gravity because it will go down fast enough anyways (as long as you don't have a humongous amount of residual backing out... but you always check that first). I figure if I want to stop it, I just pinch/clamp the tube.

Also, flush thoroughly after administering the meds!!!! It's already torturous having an NGT be forced down your nose/throat once... the last thing I'd want to do is have to extract and reinsert (a new) one because I let the meds clog it. >

[#1ME]

We administer the meds mixed together (unless there is some type of contraindication on said med), and use the 60cc syringe with the plunger to do so. I don't see anything wrong with it, unless your policy says to do so otherwise. Just remember not to push fast, because of course that will cause some GI upset, and not to push in any air. Flush with water before and after.

[dfs1961]

I flush first, administer the meds all at the same time (diluted with warm water which helps them melt a bit) and then flush again. If I have a clogger, I do push a little bit. For the most part I just do them by gravity, but then again it all depends on the patient and how much time I have (yes, that is a reality, how much time I have).

[spongebob6286, BSN, RN]

when its bolus feeding, i do it by gravity as well as the flush. but if its meds, i push it slow

[jujuseah, RN]

You are supposed to do it by gravity and never push it unless it is stuck.

You have to crush your pills till powder fine (yes it takes time and effort but for a good wash down it is worth it) and stir it with hot(not hot hot but hot enough) water.

Check for NG placement, wash clear water down check for patency, kink the tube and pour some water in the 50mls syringe (to cool down the hot meds) and then add in the meds (stirred in hot water) and watch it spiral down.

If the meds are (like omeprazole which the order should be changed to nexium which is suitable for NG) stuck, you may do gentle push! (like what else can you do.. you wouldn't want to change the tube.. right?)

If not, please try never to do pushing as it is detrimental to stomach over time. Cos pushing in seems like you are impatient and have little love for the patients hahahah

[birdie22]

thanks for the tip about the hot water! I honestly dont even know the policy at our place about gravity vs. pushing. I've seen it done both ways by a lot of nurses. We get a lot of peg tubes on our floor. I usually push with the peg and use gravity with the NG due to the higher sensitivity for the patient. Oh, and I always mix everything together except for the BP meds (in case I have to hold them with a low BP).

[Grasshopper11]

I put each medication in a separate med cup. For two simple reasons. One because that is hospital policy and two because of a experience that I had when I went to the patient's room with the medication in separate cups and the patient told me at that time that he was having diarrhea. Because I had them in separate cups, I was able to remove the liquid colace and toss it. If the meds were mixed together, liquid or crushed, I would not have been able to do that.

Also, a third reason is that if the state comes, they watch to make sure the medication is in separate cups.

Most meds go down by gravity very quickly. If the pt has gas that might slow things up a bit. On some occasions, I was giving the pt Jevity 1.5 bolus by gravity and it went a little slow but my patient was able and willing to hold it while it went through. She had to learn how to do it anyway when she went home!

What I am told, pushing fluids should only be done in the ICU. It could make them vomit, etc.