04.03 NG Tube Med Administration (Nasogastric)

Overview

1. Purpose
   1. Some patients require medications to be given via NG tube
      1. Aspiration risk
      2. Dysphagia
      3. Esophageal trauma
   2. Certain medications CANNOT be cut or crushed
      1. Extended Release
      2. Enteric Coated
      3. Delayed Release
      4. Capsules with large pellets
   3. In that case, request an alternate form
      1. Liquid solution
      2. Alternate route
   4. Other medications should be crushed and dissolved in water to be administered via NG tube

General

1. Supplies needed
   1. MAR
   2. Medication
   3. Medication cup (1 for each med)
   4. Pill crusher
   5. 60 mL catheter tip syringe
   6. Tap water (30 mL per med, plus 60-90 for flushing)

Nursing Concepts

1. Steps and nursing considerations
   1. For EACH medication:
      1. Verify using MAR, orders, and 5-rights
      2. Crush appropriately
      3. Dissolve in 20 mL water in individual medication cup
   2. For administration:
      1. Perform hand hygiene
      2. Don clean gloves
      3. Prepare medications as above
         1. Let patients know what meds they’re receiving and why
      4. Bring all medications on bedside table next to bed
      5. Remove plunger from 60 mL syringe
      6. Attach 60 mL syringe to NG tube, hold above patient’s head.
      7. Pour 30 mL water into syringe and let flush by gravity
         1. Alternatively, you can manually flush, but the gravity method is easier
      8. Pour first medication in syringe, allow to flush  by gravity
      9. Flush 10 mL water after medication
      10. Repeat with each medication, flushing with 10 mL between medications
   3. Once all meds are administered, flush with 30-60 mL tap water
   4. Do NOT reattach suction for at least 1 hour
      1. *Note – if your patient is on gastric decompression, they should NOT be receiving NG Tube medications
   5. Discard all used supplies
   6. Remove gloves
   7. Perform hand hygiene
   8. Document administration per facility policy
      1. If using Barcode Medication Administration, you will scan all medications prior to preparing them
      2. THEN you administer
      3. THEN you confirm administration in the MAR
      4. *Do NOT document a medication as given until you have actually given it
2. NOTES
   1. If a medication is required to  be given on an empty stomach, hold tube feeds for 1 hour before and after medications
      1. Collaborate with dietician
      2. May need to adjust rate and volume of tube feeds to ensure adequate nutrition
   2. Some medications should never be administered together.
      1. Verify with pharmacy
      2. Separate administration by at least 30 minutes
      3. Example – antacids can affect absorption of other meds – give 30 minutes after other medications
   3. Check back with patient 30 minutes after administration of any PRN meds to check efficacy

Patient Education

1. Indication and possible side effects for each medication
2. Purpose of med administration through NG tube