Equipment
■ Procedure gloves.
■ Water (for diluting and flushing the feeding tube).
■ 60-mL catheter-tip syringe.
■ Stethoscope (e.g., to check the apical pulse before administering some cardiac medications).
Assessment
■ For NG tubes, check tube placement by aspirating stomach contents or measuring the pH of the aspirate, if possible.
■ Other, less accurate, methods are injecting air into the feeding tube and auscultating, or asking the patient to speak.
■ Be Safe! Never rely on only one bedside method for checking tube placement; use a combination of methods. Post-Procedure Reassessment
■ Evaluate the therapeutic effects of the medication.
■ Be Safe! Be alert for adverse reactions, side effects, or allergic reactions. If present, notify the appropriate care provider.
Key Points
■ If the patient is receiving a continuous tube feeding, disconnect it before giving the medications. Leave the tube clamped for a few minutes after administering the medication, according to agency protocol.
■ Prepare the medication.
■ Give the liquid form of medication, if possible. If the solution is hypertonic, dilute with 10 to 30 mL of sterile water before instilling through a feeding tube.
■ Be Smart! If pills must be given, verify that the medication can be crushed and given through an enteral tube.
■ Crush the tablet and mix it with about 20 mL of water.
■ If you are giving several medications, mix and administer each one separately and flush afterward.
■ Don nonsterile procedure gloves.
■ Place patient in a sitting (high-Fowler’s) position, if possible.
■ Check for residual volume.
■ Flush the tube. Based on the type of tube, use a piston tip or Luer-Lok syringe. Remove the bulb or plunger; attach the barrel to the tube;
and pour in 20 to 30 mL of water.
■ Depress the syringe plunger or using the barrel of the syringe as a funnel and pour in the medication. A smaller tube or thicker medication will require use of a 30- to 60-mL syringe.
■ Flush the medication through the tube by instilling more water.
■ Have the patient maintain a sitting position for at least 30 minutes after you administer the medication.
Documentation
■ Document:
■ Medication, time, dose, and route given, assessments.
■ Therapeutic and adverse drug effects, nursing interventions, and teaching.
■ Patency, residual volume, and placement of tube.
■ Any difficulty with administering the medications.
■ Record scheduled medications on the MAR and PRN medications in the nursing notes. For PRN medications, include reason given and response.
■ When a drug is not administered, document that on the MAR along with the reason, and inform the prescriber.
■ Be Smart! Document on the I&O record the amount of liquid medication and the water used for swallowing medication or flushing the tube.
■ Some providers prescribe a specific amount of water to flush with each medication or feeding.
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| Instilling medication through an enteral tube |
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