Swallowing PO meds with NGT

[dvill2305]

I left my old hospital to work as a travel nurse. Currently working on a step-down surgical unit. At my old hospital we would always crush meds and place them down the NGT if a patient had one. However, at my current hospital the nurses on the floor administer their PO meds whole by mouth while an NGT is in place; and its all the nurses, not just one. I feel uncomfortable doing this because I feel as if this puts the patient at high risk for aspiration. What are your thoughts? Any nurse educators or experienced nurses have evidence that supports otherwise? How do I approach this without being the "At my old hospital" person?

[offlabel]

An NGT is a mechanical impediment to a tablet or pill passing to the gastric mucosa. They're not designed to dissolve and be absorbed while wedged between the NGT and esophageal wall.

I'd definitely take this to the supervising pharmacist and let that person and your nurse manager duke it out.

[bscri4821]

What is keeping you from continuing the practice of crushing your meds and squirting them through the tube? Is there some policy that specifically states that you HAVE to allow the patient to swallow pills? As a follow up, are the NG tubes, or smaller bore feeding tubes? I have seen speech therapy assess patients with large bore NG tubes, and they have passed them off for PO medications and thin liquids. Maybe you should go that route?

[cayenne06, MSN, CNM]

An NGT is a mechanical impediment to a tablet or pill passing to the gastric mucosa. They're not designed to dissolve and be absorbed while wedged between the NGT and esophageal wall.

I'd definitely take this to the supervising pharmacist and let that person and your nurse manager duke it out.

I dont think a standard NGT in an adult patient would be an impediment to PO meds, assuming there isn't another reason to avoid them. But this is not my area of expertise so i could be wrong!

[MaxAttack, BSN, RN]

I think the bigger question is if the patient can safely tolerate PO medication, why is there a NGT?

[delphine22]

I think the bigger question is if the patient can safely tolerate PO medication, why is there a NGT?

Gastric decompression?

[chare]

I think the bigger question is if the patient can safely tolerate PO medication, why is there a NGT?

I've occasionally seen this in pediatric burn patients with a high caloric requirement. They allow them to eat most anything they want during the day, and supplement with ND feeds overnight.

[jdub6]

I've seen this in both peds and adult pts-think of the cancer patients who have home ng tubes for semi long periods of time due to weight loss. I have never heard of someone in that type of situation being told they had to modify their po intake just because of the tube, and while i guess i never heard this addressed directly i feel that if there are no dietary restrictions then pills are probably okay too. I guess i don't understand how the nf would increase aspiration risk since it goes down the esophagus while aspiration involves something going into the trachea. And i don't know that a pill would be any more likely to get "stuck" partway down due to thetube than certain food items would.

Also there are some meds that can't be crushed and others that are much more difficult or expensive to give down a tube-examples being dilantin which has to have nothing down the tube for intervals before and after and there are many meds which must be given in liquid diem if using a tube and that can be very expensive

[William2]

I've seen this in both peds and adult pts-think of the cancer patients who have home ng tubes for semi long periods of time due to weight loss. I have never heard of someone in that type of situation being told they had to modify their po intake just because of the tube, and while i guess i never heard this addressed directly i feel that if there are no dietary restrictions then pills are probably okay too. I guess i don't understand how the nf would increase aspiration risk since it goes down the esophagus while aspiration involves something going into the trachea. And i don't know that a pill would be any more likely to get "stuck" partway down due to thetube than certain food items would.

Also there are some meds that can't be crushed and others that are much more difficult or expensive to give down a tube-examples being dilantin which has to have nothing down the tube for intervals before and after and there are many meds which must be given in liquid diem if using a tube and that can be very expensive

If thats an issue give dilantin IV with a filter.

To the OP, interesting observation. Travel nursing has been in my sights and I've been thinking the "what if.." What if the place I go to in my mind is "ass backwards" would be I be able to get through it long enough until my contract ends. Remains to be seen.

For you I wouldn't care if that's what all other nurses do. Who cares about them.

If I was you I would do what you feel comfortable with. In my opinion, I'm opening up whatever med or crushing whatever I have to and pushing it down that NG because that's what I know and that's what I'm doing. My room my rules mentality isn't always what other people like to hear but as long as your license remains intact and patient safety is upheld I see no issue. In fact to me their at less of an aspiration risk using that NG.