Drug Administration Via Enteral Feeding Tubes (Nursing)

00:00 Welcome to Enteral Tube Drug Administration Through a Nasogastric Tube. Let's take a look at our equipment. So we need the medication we're going to administer. We also need absorbent pad or maybe a towel to help protect the patient's clothing. We're going to need a piston syringe and this is going to be really useful to help check gastric residual or help administer the medicine. We need purified or tap water. Also, we're going to need medicine cup for each medication we're going to administer. So before we start, when we prepare our medication for administration, we want to make sure that we use the 7 rights of medication administration. So don't forget about the right patient, the right drug, the right reason, the right route, so make sure to review all these before you give your patient's meds.

00:55 Now, don't forget your hand hygiene and we're going to put on our gloves. Now, before, if you remember any time we put anything through the nasogastric tube, our patient's head of bed needs to be at least 30 degrees. Now for administering something down the tube, if they can tolerate it, the higher the better. So anywhere from 30 to about 90 degrees is great. Now, once we go to give medications, we need to consider what we're going to give through that tube. If it's liquid medications, it's much easier to put that through the tube.

01:27 Now, we may have to give something ordered that's in a tablet or a pill form. We need to be really conscious can it be crushed. So, if you remember from medication administration, if it's a continual release and extended release or a sustained release medication, then we cannot crush that and that's not recommended. You're going to want to talk to your doctor and see what alternative you can use. So again, if it's a pill that ends with CR, ER, or SR we don't want to crush these medications. Now, we want to place each medication into a separate medication cup and add warm water. Warm water especially is going to help dissolve those medications. Now, here you notice that we're talking about giving that med individually, so that really is best in regards to compatibility issues with your medications.

02:23 Now, I will tell you in practice sometimes you will see a nurse give it altogether. That's actually really common, but best practice is to give that medication individually. Now, we want to stop the tube feeding if it's running and clamp that tube before we administer our meds. Then we want to make sure that that tube is at the correct insertion length. So, when the patient's tube was inserted, it should have been at a predetermined length and we want to make sure it's still in the right place. One good way to check that is aspirate gastric contents with your piston syringe and then unclamp the tube. Once we do that, we want to make sure that we put that gastric content back because we never want to get rid of gastric contents, that's the patient's normal flora and their normal gastric contents.

03:14 So we don't rid our patient of that. Then we want to flush the tube with at least 15 ml of tap water. Now we can administer each medication separately either using that by gravity or by the piston syringe and then flushing between each medication, and we're going to flush that with tap water. Now when all your medications had been administered, you're going to flush the tube again with at least 15 ml of water. So always just think flush before and flush after. Now we can clamp our tube, remove the syringe, and restart the tube feeding for our patient. Now let's take a look at medication administration to the nasogastric tube. So before we get started, when we prepare the medications itself, we really need to make sure we look at what kind of drug was given. So for looking at a tablet, for example, it may be a continual extended release or sustained release like we talked about earlier.

04:14 Now those are meds that you don't want to crush and you want to check with your provider.

04:18 Also, some of the medications that come in pill form, they have alternative routes so it could be maybe a liquid or maybe a dissolved particle or something like that that would be much better to go into a nasogastric tube. So take a look at your meds before you go to the bedside. So now we want to perform our hand hygiene, and then we want to put on our gloves. Now if you remember from earlier, always when you're going to give something through the NG tube, the patient's head of bed has to be up. So do you remember how high? Alright, so if you remember, just to recap, always 30 degrees at least. The higher the head of the bed, the less aspiration risk you're going to get. So at minimum, 30 degrees, 90 is really best. Okay, so before we get started here, you see that I've got my meds in each different cup. So some of these are liquids and some of these are pills. So you can see this one I check, this one could be crushed. So you can even see some of the little dissolved pill particles. So really before you start if you've checked your medication order, made sure you're doing the 7 rights of medication administration, it's really nice to prepare those so it gives him a little time to dissolve. Okay, so now that I've got this ready, I'm going to make sure on my patient that the patient's nasogastric tube is in the right place before I put anything down it. So how we're going to do this is I'm going to take my piston syringe and check that. So before we do that, let me show you one more thing. Okay, on the nasogastric tube, okay the patient's got his regular nasogastric tube in. This is something called a Lopez valve. This is really handy that we talked about earlier. So, this Christmas tree part, this little stock piece, this is the one that's going to go to the patient's nasogastric tube. So we're going to squeeze this part in. So that fits really nicely there. Then, this is the medication port or if you have a bolus tube feeding, for example, you can put it through there. This port right here, this is the one if the patient has continuous tube feeding running at all times and I need to deliver meds, I can use this medication port. But, the patient has nothing running right now so I'm just going to use this one, and we commonly use this one as well, just because maybe it's bigger. Okay, so one thing to look at as well, don't forget on the Lopez valve we've got a little valve shut off and on. So you see when I've got the off, that's running in line with my tube, that means nothing's going to spill out and I can't push anything in. Alright, so now let me show you the on switch. We're going to turn this and now see how my arrows are running parallel with the tubing, now we know we can infuse stuff in there. Okay, so now that that's on, I want to make sure my patient's covered, so a towel and absorbent pad, whatever you've got. Okay, nasogastric tubes can be a little messy sometimes, we want to make sure our patient's taken care of. Okay, so to check placement before we put anything through it. I'm going to uncap this. Now, every time you uncap a nasogastric tube, be aware that stuff can spill out so hold it high so it doesn't get on you and your patient. Okay, so I'm going to take my piston syringe. This fits really nicely in here.

08:16 And then to check for gastric contents and check for confirmation, we simply pull on the back of the plunger and aspirate if there are any gastric contents on here. This is a really good time to examine this. Now, it can be lots of different colors, it can be like a green or a brown.

08:33 One thing to note if you see a lot of black maybe, a lot of red, looks like bleeding's in there, you may want to stop and notify the provider. Okay, so now that we've confirmed placement and check gastric contents, always put back the gastric contents back in. We don't want to rub our patient of their normal gastric flora. So now that we've checked contents, we're good here. I'm going to turn that off for a moment. Okay. Now, one thing I want to talk about is you notice that every time I hook this I don't want to be pulling back excessively if I don't have to because that can cause unnecessary pressure and suction on the stomach when we don't need to. So just keep that in mind. Okay, I'm going to remove my piston or the plunger and then we're going to give our medication. So, I've confirmed placement. I'm putting on my piston, I'm making sure my Lopez valve is on for flow and before I give medications we always flush our tubing first. So, this kind of take some dexterity. A lot of the times, you want to hold on here, hold on to the nasogastric tube and hold on to the piston. So I'm going to flush a little bit of water. So when we flush, and I'm being conservative here, but when we flush notice that I can either let it go by gravity or I can use my piston to help me as well. So I'm going to go ahead and use my piston to help. So I'm going to place this in here. What I want you to notice when I do this, I'm going to push down slowly. I also don't want to bolus a large amount of air in the patient's stomach. So as soon as the water goes in, notice I don't keep pushing on the piston syringe, I'm going to stop and turn off the stopcock.

10:40 So now that's off I can detach because if I keep pushing down all of the air will go in my patient's stomach.

10:50 Okay. So now that we flushed, let me take the plunger out.

10:58 We're going to give our medication.

11:02 I'm going to turn on my stopcock and turn on my Lopez valve and then I'm going to give my first medication.

11:09 So I'm going to take this, I'm going to pour this in, and sometimes you may see the nurses give a little swirl.

11:22 Also, to help it facilitate drainage, we may put a little tap water behind it.

11:30 So there's some variations on this.

11:33 You may see us wiggle something like this, but you want to flush after each medication and that's going by gravity for me so that's great.

11:45 So next, I want to show you this one.

11:48 Sometimes you're going to see some sediment at the end on a maybe a crush pill or something like it.

11:55 This can be caught up a little bit, so what I recommend is once you pour this in add some water.

12:04 And notice some of my sediments still in there so what I'm going to do is add a little bit more water, there we go, to make sure I get all of that medication.

12:16 And then you'll kind of see me swirl just to help facilitate some drainage.

12:21 And again, you can use your plunger at this point that's fine, too.

12:25 Okay, so now let's not try to go in by itself, so this is a good time to use your plunger.

12:34 And it started flowing for me so I needed very little pressure to go on through.

12:42 So now I can disconnect, turn off my stopcock, and take out my plunger so I can flush.

13:08 And, again, you can do this by gravity or you can use your plunger as well.

13:14 Just make sure you don't bolus a lot of air into the patient's stomach.

13:18 And now, since I just flushed, I'm going to give my last medication.

13:29 Also you notice the higher up that I go by gravity, if, it definitely helps facilitate drainage.

13:35 And now I'm going to flush.

13:44 So just remember flush, med, and then flush, each time.

13:57 Okay, so that's going down nicely.

14:00 I'm going to turn my stopcock back off so we don't loss anything that we just put in.

14:08 And, now, this is a great time if I had continuous tube feeding running I would put that clamp back in and then I would restart the tube feeding, but for now, I just put on my cap and then that's off.

14:23 Now, now that I've given the tube feeding to my patient, I still want to keep their head of bed up for a few more minutes at least maybe 30 minutes to an hour to reduce aspiration and to help facilitate digestion for our patient.