Administering Medications via a Gastric Tube

Goal: The patient receives the medication via the tube and experiences the intended effect of the medication.

1. Gather equipment. Check each medication order against the original in the medical record, according to facility policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Perform hand hygiene.

4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.

5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.

6. Prepare medications for one patient at a time.

7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.

8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.

9. Check to see if medications to be administered come in a liquid form. If pills or capsules are to be given, check with pharmacy or drug reference to verify the ability to crush or open capsules.

10. Prepare medication. Pills: Using a pill crusher, crush each pill one at a time. Dissolve the powder with water or other recommended liquid in a liquid medication cup, keeping each medication separate from the others. Keep the package label with the medication cup, for future comparison of information. Liquid: When pouring liquid medications from a multidose bottle, hold the bottle with the label against the palm. Use the appropriate measuring device when pouring liquids, and read the amount of medication at the bottom of the meniscus at eye level. Wipe the lip of the bottle with a paper towel.

11. When all medications for one patient have been prepared, recheck the label with the MAR before taking the medications to the patient.

12. Lock the medication cart before leaving it.

13. Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.

14. Ensure that the patient receives the medications at the correct time.

15. Perform hand hygiene and put on PPE, if indicated.

16. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the CMAR/MAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient for the second source.

17. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain what you are going to do, and the reason for doing it, to the patient.

18. Scan the patient’s bar code on the identification band, if required.

19. Assist the patient to the high Fowler’s position, unless contraindicated.

20. Put on gloves.

21. If patient is receiving continuous tube feedings, pause the tube-feeding pump.

22. Pour the water into the irrigation container. Measure 30 mL of water. Apply clamp on feeding tube, if present. Alternately, pinch gastric tube below port with fingers, or position stopcock to correct direction. Open port on gastric tube delegated to medication administration or disconnect tubing for feeding from gastric tube and place cap on end of feeding tubing.

23. Check placement of tube, depending on type of tube and facility policy. (Refer to Chapter 11, Nutrition.)

24. Note the amount of any residual. Refer to Chapter 11, Nutrition. Replace residual back into stomach, based on facility policy.

25. Apply clamp on feeding tube, if present. Alternately, pinch gastric tube below port with fingers, or position stopcock to correct direction. Remove 60-mL syringe gastric tube. Remove the plunger of the syringe. Reinsert the syringe in the gastric tube without the plunger. Pour 30 mL of water into the syringe. Unclamp the tube and allow the water to enter the stomach via gravity infusion.

26. Administer the first dose of medication by pouring into the syringe. Follow with a 5- to 10-mL water flush between medication doses. Follow the last dose of medication with 30 to 60 mL of water flush.

27. Clamp the tube, remove the syringe, and replace the feeding tubing. If stopcock is used, position stopcock to correct direction. If tube medication port was used, cap port. Unclamp gastric tube and restart tube feeding, if appropriate for medications administered.

28. Remove gloves. Assist the patient to a comfortable position. If receiving a tube feeding, the head of the bed must remain elevated at least 30 degrees.

29. Remove additional PPE, if used. Perform hand hygiene.

30. Document the administration of the medication immediately after administration.

31. Evaluate the patient’s response to medication within appropriate time frame.