ADMINISTRATION OF MEDICATION THROUGH TUBES

1. ADMINISTRATION OF MEDICATION THROUGH TUBES NUR 104 Module F

2. GASTROINTESTINAL TUBES • Nasogastric (NG) tube—used to intubate the stomach by way of the nasal passages • Gastrostomy tube—placed through a surgical incision in the stomach • Jejunostomy tube—placed surgically into the jejunum

3. Nasogastric Tube • Used in patients with impaired swallowing, who are comatose, or have a disorder of the esophagus • Use the liquid form of the medication when possible • Can crush tablet or pull capsule apart and mix with water • DO NOT crush or open enteric-coated or delayed release capsules

4. Continued…

5. Procedure for administering medications • Assemble all needed equipment • Follow the 6 Rights of Drug Administration: • Right Drug • Right Time • Right Dose • Right Patient • Right Route • Right Documentation

6. Glass of water 60cc catheter tip syringe Stethoscope Medication profile Gloves Equipment Needed…

7. Technique • Check medication profile for correct patient, medication, dosage, route, and time • Verify patient’s ID by bracelet • Explain what you will be doing to the patient • Verify placement of tube before administering any liquids • Method 1—Put on gloves and place stethoscope over the stomach; using catheter tip syringe, insert 10cc of air into the NG tube and listen for a gurgling sound; withdraw the amount of air inserted

8. Method 2—Put on gloves and unclamp the NG tube; place tube next to your ear and listen for gurgling timed with respirations; if heard, tube is probably in the lungs and should be removed and reinserted Once placement has been verified, clamp tubing and attach syringe; pour the medication into the syringe and unclamp the tubing; allow the medication to run in by gravity Continued…

9. Reclamp the tubing and add approximately 50cc of water; unclamp and allow the water to run in by gravity; reclamp the tube as soon as the water has gone in DO NOT ATTACH THE NG TUBE TO SUCTION FOR AT LEAST 30 MINUTES AFTER GIVING MEDICATIONS Provide oral hygiene Record all water as intake Continued…

10. Gastrostomy Tube

11. Jejunostomy Tube

12. Placement Verification of G-tube and J-tube • Put on gloves and clamp tubing • Attach 60cc syringe to tubing and aspirate stomach contents • Notify MD if residual (amount aspirated) is greater than 100cc • Re-instill aspirate • Flush with 30cc water • Administer medication as with NG tube

13. Rectal Suppositories • Suppositories dissolve at body temperature • Should be stored in a cool place to prevent softening • Should not be used for patients who have had recent prostate or rectal surgery or trauma

14. Administration of Rectal Suppositories • Assemble medication and wash hands • Follow the 6 Rights of Drug Administration • Verify patient’s identification and explain procedure • If possible, have patient defecate prior to administration • Place patient on left side in Sim’s position • Put on gloves

15. Continued… • Open the suppository and apply water-soluble lubricant • Place the tip of the suppository at the anus and ask patient to take deep breath in and out • Insert the suppository approximately 1 inch • Keep patient on side for 15-20 minutes to allow for absorption of the medication • Remove gloves and wash hands

16. Continuous Bladder Irrigations • Continuous infusion of a sterile solution into the bladder • Usually a triple-lumen catheter—1 inflates balloon, 1 irrigates, and 1 drains • Usually following genitourinary surgery to keep bladder clear and free from blood clots and sediment

17. Continued…

18. Continued… • MD will order solution, strength, and flow rate • Label the bag “GU IRRIGATION ONLY” • Spike bag with irrigation tubing using aseptic technique • Close clamp on tubing and fill chamber half full with fluid, unclamp tubing and fill to remove all air, and close clamp • Clean port with antiseptic swab

19. Continued… • Calculate drip rate and adjust roller clamp • Observe intake and output • If intake continues to be greater than output, the catheter may be blocked by a blood clot—over-distention can result in discomfort, bladder damage, or rupture

20. Vaginal Irrigations • Douche • Not necessary for normal hygiene but may be required if a vaginal infection and discharge are present • Not an effective method of birth control

21. Continued… • Procedure • Wash hands • Follow 6 Rights of Drug Administration • Provide privacy • Explain the procedure • Put on gloves • Ask patient to void and place on the bedpan • Hang bag of solution on IV pole approximately 12 inches above vagina

22. Continued… • Apply water-soluble lubricant to plastic vaginal tip • Cleanse the vulva by allowing a small amount of the solution to flow over • Gently insert the nozzle directing it down and back 2-3 inches • Hold labia together to facilitate filling the vagina • Rotate the nozzle to irrigate all parts • Intermittently release the labia to allow solution to flow out

23. Continued…

24. Continued… • After all of the solution has infused, have patient sit up and lean forward to thoroughly empty the vagina • Dry external area • Discard equipment and wash hands