The following is a link to a recent article from the October 2009 issue of AJN about tube feeding, and how it should be performed. I know that we aren't supposed to mix meds or combine meds with feeding. Plus, we should flush between each med. However, I was surprised to see that it states sterile water should be used for flushing and diluting through a G-tube, not tap water:
A few questions: do any of you use sterile water for tube feeding medications? If tap water is bad for tube feeding meds, then shouldn't it also be bad for oral medications? Or to have patients/residents drinking it, in general? (Or us, for that matter?!) I was never taught to use sterile water in school for tube medications.
Sterile water meets United States Pharmacopeia standards. Tap water should not be used; it can and often does contain contaminants, including pathogenic microorganisms, pesticides, pharmaceuticals, and heavy metals that might interact with a drug and reduce its bioavailability.
How is this dfferent from swollowing medications with tap water (i.e. taking a pill)?
Oh, you can't take PO meds with tap water!! It's so contaminated!! You must use sterile water, poured into a single use, sterile specimen cup . . . and don't forget, you must "glove up" to put the pill into the special, sterile pill cup . . . and don't forget to create a sterile field on the patient's tray table!! OMG!!! Let's get real!!:uhoh3:
Maybe it is one of those culture change initiatives, where offering the client anything but the cleanest, purest substances indicates a lack of client-centered care?
Ok, so I can kinda understand the chemical arguement of mixing crushed pills together being different than mixing whole pills. But what about in a longterm care environment where sometimes the majority of the patients get their pills crushed and taken orally? Yet it is ok to crush all of those pills together and let them drink tap water afterwards. Is this different?
This all does seem very expensive and excessive, unless under specific circumstances like neotropenic pts or perhaps neonates.
I've always wondered about why tube fed meds cannot be mixed together, nor crushed together, but oral meds can be given together. I mean, for tube meds, you put one in, flush with water, then put another one in, so only a few seconds separates the medications. Do those few seconds really make a difference in preventing interactions, since they'll all be together in the stomach?
I agree with you about the time issue, too.
I was taught that the reason you crush each med separately is so if something should happen to your med cup, like if you spill or knock it over, or if the tube closes off that you know exactly which meds the patient has gotten and which ones they haven't. If they are all mixed together and you accidentally spill half or something then you don't know which meds were actually delivered and they are missing their medications or getting a double dose because it's not like you can just give them the ones they didn't get.
Oh, you can't take PO meds with tap water!! It's so contaminated!! You must use sterile water, poured into a single use, sterile specimen cup . . . and don't forget, you must "glove up" to put the pill into the special, sterile pill cup . . . and don't forget to create a sterile field on the patient's tray table!! OMG!!! Let's get real!!:uhoh3:
This sounds like Excelsior College standards for the CPNE!
i dont think it can be used because bacteria or whatever else is in the water can get caught in the tube. Acidity of gastric contents usually kills whatever is in tap water so oral is ok. where as if if was sitting in a tube....bacteria could grow.
Also i do know some tap water, or city water, can contain chlorine. im no water expert so id ont know what else is in tap water but that much i do know.
I just saw a HOUSE where the patient had Legionnaire's and and an amebic infection from stealing water from a roof cistern contaminated by pigeon poop. He died. I didn't even know cisterns were still in existance.
My grandma had one. I remember drinking from it growing up, so about 20 years ago, the water had little squigglies in it. I survived but I can understand saying THAT isn't the best for giving Gtube meds. :)
I was taught that the reason you crush each med separately is so if something should happen to your med cup, like if you spill or knock it over, or if the tube closes off that you know exactly which meds the patient has gotten and which ones they haven't. If they are all mixed together and you accidentally spill half or something then you don't know which meds were actually delivered and they are missing their medications or getting a double dose because it's not like you can just give them the ones they didn't get.
Yes, I admit that this is a good reason to crush meds separately. In practice, however, if a patient with a G-tube has multiple medications, such as the 30 that txspadequeenRN mentioned in her post, imagine how long that med pass would take for one person.
If only 20 of the the 30 meds have to be crushed separately (rest in liquid form), that's 40 med cups for that one patient alone. That would take some time. Then, add the time to carry 20 separate crushed meds, plus the 10, into the patient's room. Since we aren't supposed to leave meds on the top of the cart, one would have to crush 1 to 4 meds, bring them into the room, then come back multiple times, as it would be impossible to carry all 20 crushed (and 30 total) into the patient's room at one time.
Then, each of the 30 has to be put into the tube one at a time, with flushes (of sterile water) in between. Doing tube meds this way would take a lot of time away from the other 30 or so residents that those of us who work in LTC have to care for.
The gastric juices will kill anything clogging the tube...our stomachs job.Also is someone is using sterile water only through the stomach tube of someone who is SL or isn't even a canidate for a line (home care), make sure that they are receiving a supplement of every possible electrolyte available as well as iron and other essentail elements-after all tap water is how the general population gets these things that we must have to survive.Some people believe everything that they read without even thinling it through for themselves...esp in nursing....I foresee a lot of problem in the future of these patients-After all a "sterile gut" is a very bad thing
the gastric juices will kill anything clogging the tube...our stomachs job.also is someone is using sterile water only through the stomach tube of someone who is sl or isn't even a canidate for a line (home care), make sure that they are receiving a supplement of every possible electrolyte available as well as iron and other essentail elements-after all tap water is how the general population gets these things that we must have to survive.some people believe everything that they read without even thinling it through for themselves...esp in nursing....i foresee a lot of problem in the future of these patients-after all a "sterile gut" is a very bad thing
ironically, we'll have to add culturelle or another probiotic to the 30 meds we're giving with the sterile water. :)
This sounds like Excelsior College standards for the CPNE!
OMG that reminds me of when I worked a few agency shifts last year at a place where state was doing its survey. One nurse told me that she found out that they were requiring us to more or less set up a field to check blood sugars, for Pete's sake. I think what she said exactly is we were not allowed to set down the glucometer on the bedside table unless there was draping or a clean towel underneath, so she was just going into the rooms and doing everything one-handed so she would not have to set anything down. Good grief, Charlie Brown. Some people are becoming so germaphobic in our society that I think they are contributing to the growth of these resistant bugs....oops, sorry for the segue. Back to regular scheduled programming.
:uhoh3:
that txspadequeenRN mentioned in her post, imagine how long that med pass would take for one person.
sunnycalifRN
902 Posts
Oh, you can't take PO meds with tap water!! It's so contaminated!! You must use sterile water, poured into a single use, sterile specimen cup . . . and don't forget, you must "glove up" to put the pill into the special, sterile pill cup . . . and don't forget to create a sterile field on the patient's tray table!! OMG!!! Let's get real!!
:uhoh3: