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?

[Pepper The Cat, BSN, RN]

the only way to be sure if it's safe to crush and mix is to look it up or call the pharmacy

I had pharmacist who couldn't understand why I kept asking for non-enteric coated ASA. She said we should just "drop the pill down the tube whole". I had to walked away before I laughed in her face.

[lovemydeano]

:clpty::clpty:Well, I was taught to do them one at a time, flush after each med, but really, they are all going to the same place! Some people say they may react if all are administered at the same time. Many patients take a handful of meds all at once!!! I have had patients with peg tubes that receive 10+ meds. That's a lot of water between meds, not to mention the feedings and the flushes!!! To each his own, I do it all together, though.

[Kyrshamarks, BSN, RN]

Most pills are actually a powder that is formed into a pill thru the application of pressure. That is what holds the pills together (now granted capsules are different but you you do not crush granule meds) So he rationale that powdered meds change chemically are not correct. They are in a powder state technically still. A powder is a powder is a powder no matter how that powder is given in a powder form.

[mariahas4kids]

I was taught and do one at a time. I've seen what happens when a glob forms in a tube because different meds did not mix well with others. As for the rational that they all go to the same place, well, the pills won't dissolve and react until they reach the stomach, a much larger place to have a reaction than your throat or a tube. Just like you check the compatibility of IV meds, the compatablility of crushed and mixed meds would need to be checked.

[NotFlo]

If a person takes their meds crushed in applesauce, do you crush each one separately and give each one in a separate spoonful of applesauce? Couldn't the same "chemical reaction" we've been warned of if we give them down a peg together happen if we crush them together for a pt. that takes them PO? I have dealt with many dementia patients who will only take their meds in one spoonful. I'd never be able to get them in one by one.

[kcochrane]

I crush them all and administer them at the same time. When I worked in LTC, if I had administered then all one at a time, med pass would have taken hours.

I'm with NotFlo, if the theory of chemical reaction is true, then it would be true for those we crush in applesauce.

[makes needs known]

They told us is, if unable to administer all medications via tube, you could accurately tell which ones they got and which ones they did not get. Also do you check for placement prior to meds/ feedings?

[KaitRN]

*text book answer* Crush each seperately and administer seperately with 15-30 cc of warm h20 in between..

In the real world, I don't have time to give them all seperately!! But I guess use your own judgement!!

[Forever Sunshine, ASN, RN]

I crush them all together.. and mix with water. I flush the tube with 50ccs of warm water first then the meds.. then any supplements they have ordered.. then again flush with 50ccs of water.

I do not have the time to give each med separately. Obviously if you were being observed that is the way you would do it.

[lovemydeano]

I worked on an Alzheimers/dementia unit in the past, and sometimes you do only get one shot, some you better get it all on one spoonful and hope they get some of the benefit!! For those patients who get a ton of meds, sometimes you have to be selective to get the priority meds in, I'm not going to lose sleep over a vitamin c, but the lasix, dig, k, etc., well, we know the routine:)

[Forever Sunshine, ASN, RN]

I worked on an Alzheimers/dementia unit in the past, and sometimes you do only get one shot, some you better get it all on one spoonful and hope they get some of the benefit!! For those patients who get a ton of meds, sometimes you have to be selective to get the priority meds in, I'm not going to lose sleep over a vitamin c, but the lasix, dig, k, etc., well, we know the routine:)

Sometimes if they don't take it in one shot..I label the cup and put it aside and then I come back about 15 minutes later. and get that last spoonful in.