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04.03 NG Tube Med Administration (Nasogastric)

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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

Reference Links

Video Transcript

In this video we’re going to look at administering medications through an NG Tube. There’s a separate video for crushing pills, so make sure you watch that one to know how to prepare the meds. Also – never, ever, ever, skip your 5 rights. Make sure you’re checking these meds against your MAR and your orders before you administer them. Now that we got the safety disclaimer out of the way, let’s focus just on the actual administration part.

Let’s say we have three medications to give. They’ve all already been crushed. Now I’m going to mix each one of them with 20 ish mLs of water. Remember tap water is fine with an NG tube.

I also need to have plenty of water available to flush before and after each med, so I have this cup of water here as well.
Now you want to remove the plunger from your 60 mL syringe and connect it to the NG tube and hold it at or above the patient’s head. The higher you hold it, the faster the fluid will go down, and vice versa.

Start by flushing about 30 mL of water – pour it into the syringe and let it flow in by gravity. You COULD manually flush these, but this method is WAY easier!

Now we will pour in our first medication and let it flow in by gravity. Then we follow that with at least 10 mL of water to flush it.

Then we repeat that with each medication, flushing at least 10 mL of water between each one, until we’ve done all of them.
Then you’re going to finish by flushing about 30 to 60 mL of water at the end. I like to do this in spurts of 20-30 just to make sure I’m getting everything out.

Now you can clamp your NG tube, or reattach the Tube Feeds.
And now that the meds are actually administered, you can officially document them – remember your 6th right of med administration.

We added a few extra notes in your outline for things to be aware of – like if meds shouldn’t be given together, or if they should be given on an empty stomach. So make sure you’re looking at those things as well.

And, of course, follow your facility policy when it comes to documenting meds, especially if you guys are using barcode scanning. Either way – don’t officially document it until the meds are fully administered. Now, go out and be your best selves today. And, as always, happy nursing!

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