Definition
Administering medication through a nasogastric tube (NG) is a critical nursing procedure for patients who cannot take medications orally. It requires careful preparation to ensure tube patency, accurate dosing, and patient safety.
Purpose
- To provide medications to patients who are unable to take it through oral route.
Articles
- All articles required for tube Feeding.
- Water (15–30 mL for adults; 5–10 mL for children)
- Pill crusher (if tablets are allowed to be crushed)
- Gloves
- Towel or mackintosh
- pH strips (for placement verification
- Medications to be administered.
- Medicine containers.
Clinical Considerations
| Aspect | Details |
|---|---|
| Tube Size | Use ≥8 Fr for tablets; smaller tubes increase clogging risk. |
| Formulation Suitability | Prefer liquid, dispersible, or soluble forms. Avoid enteric-coated, sustained-release, or cytotoxic drugs unless approved. |
| Jejunal Tubes | Require sterile water for flushing; absorption may be reduced—monitor therapeutic effect. |
| Feeding Interruption | Pause feeds 30 minutes before and after drug administration (unless otherwise directed). |
| Drug-Nutrient Interactions | Some drugs (e.g., phenytoin, ciprofloxacin) bind with feeds—space administration or adjust dose. |
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure Identify the patient and check physician’s order. | Avoids medication error. |
| 2. | Allow liquid medications (if cold) to warm to room temperature. | Cold liquids cause discomfort to patients. |
| 3. | If tablets are to be administered, crush it into fine powder and mix it in sufficient amount of water (follow oral medication administration principles in preparing and administering medications). | Prevents clogging of tube. |
| 4. | During procedure Wash hands and don gloves | Reduces transmission of organism and contamination of medicine. |
| 5. | Place a mackintosh and towel over the chest. | Protects patients from spillage. |
| 6. | Elevate the head of bed 35 to 45 °. | Protect the patient from the aspiration. |
| 7. | Assess the placement of the tube. | |
| 8. | If placement of tube is correct, flush the tube with 15-30 mL water (adults) and 5-10 ml (children) before giving the medication. | It determines whether the tube is clogged and helps in maintaining patency. |
| 9. | Administer the prepared medication in the same manner as feed is administered. Administer each medication separately and flush with 5 ml of water after each. Do not mix medications. | |
| 10. | After administering the prescribed medication, flush the tubing with at least 30 cc of water. | Prevents clogging of feeding tube. |
| 11. | After procedure Observe patients for any adverse reactions. | |
| 12. | Record the procedure-total intake, medication administered, dose, time, etc. in the intake and output record as well as in the nurse’s notes. |
Troubleshooting Common Issues
| Problem | Solution |
|---|---|
| Tube blockage | Flush with warm water or use enzyme-based unclogging agents. Avoid soda or juice. |
| Medication reflux | Elevate head of bed and slow administration rate. |
| Incompatibility | Administer drugs separately with water flushes in between. |
| Viscous liquids | Dilute with water before administration to prevent clogging. |
Special Considerations
- If more than one medication needs to be administered, it should be given separately, and water should be used to flush between each drug.
- Disconnect a continuous tube feeding before giving medications and leave the tube clamped for a short period of time after the medication has been given according to agency protocol.
- Check the patient’s record for fluid restrictions and the total amount of fluids used for administering medication should be within the level of restriction.
- Medications should not be given with food.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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