Tube delivered meds

[makes needs known]

When you administer medications by tube do you crush and put them all together, and give, or do you give each med separately?

[SillyInScrubs]

I always give each med separately and flush with a little water in between.

[Pepper The Cat, BSN, RN]

I put them altogether with warm water and give them all at once. I don't have time to give them one at a time! I flush the tube with water before and afterwards.

[April, RN, BSN, RN]

I crush them all together and give them all at once. A lot of patients take a whole mouthful of pills at once so really, what's the difference? It's all going to the same place.

Also, if you give each med separately, you end up giving a lot more free water with the extra flushes. This could have a negative impact on patients who are fluid overloaded, have sodium imbalances, etc.

[SlightlyMental_RN]

I have done both ways, but I prefer to crush them all together and do the flush before and after.

[WSU_Ally_RN, BSN, RN]

My hospital's policy is one at a time... their rationale is that once crushed, you don't know how one powder/liquid may interact with others.

[JoMark06]

I remember in nursing school we gave them one at a time with flushes in between. I remember thinking that was an awful lot of water for someone who may not tolerate all that fluid in their stomach especially with continuous or bolus feeds.

So, now, depending on how many pills it is, I give it all together with flushes in between. That's how I was taught by my preceptor when I started my first job.

[makes needs known]

Thanks, I have always mixed them all together, too. But new policy is to give separately. Dissolve each crushed med in 5 ml of water, flush before and when done giving all meds. Curious to see how well a 80mg Zocor mixes with 5ml water. I will try.

[April, RN, BSN, RN]

My hospital's policy is one at a time... their rationale is that once crushed, you don't know how one powder/liquid may interact with others.

I've heard this rationale too, but wouldn't they react the same way once in the stomach if that were the case?

[WSU_Ally_RN, BSN, RN]

I've heard this rationale too, but wouldn't they react the same way once in the stomach if that were the case?

I suppose so, but they tell us with all the stomach acid down there its not the same...

[SillyInScrubs]

I was told by my preceptor during my senior practicum that the chemical properties of certain medications are altered when they are crushed, so the only way to be sure if it's safe to crush and mix is to look it up or call the pharmacy. To me, it seems faster to just do them separately than to call the pharmacy. If the patient can handle the fluid, of course. If I know for a fact that certain meds can be mixed safely, I will only combine those ones.

[anon456, BSN, RN]

In nursing school right now we are being taught to give them one at a time and flush in between. The rationale is if they vomit, you know which meds they got and which ones they didn't get yet.

In the hospital, I saw the pills mixed and put down together because the patient couldn't handle that much fluid volume. They had an NG suction tube and were just trying tolerate feeds again. The suction tube was clamped for 30 minutes after the meds were given.

Other times I saw them combined for convenience in permanent PEG tubes.