Test 2 Review: Enteral Feeding Access Devices and Medication Administration

Small-bore feeding tube (Dobhoff, etc.)

• Used for nutrition/meds, not suction.

• More flexible and narrower (requires gentle flushing).

• Placement verified by X-ray before first use.

Nasogastric (NG) tube for decompression

• Larger bore (Salem sump).

• Used to remove stomach contents (suction).

• Not primarily for meds—but if you must, you can with modifications (see below).

Giving Medications into an NG for Suction

you can give medications through an NG tube to suction only if ordered and if suction is paused

How to give meds into NG for suction

• Stop suction.

• Flush with 15–30 mL water before medication.

• Administer medication(s)—each separately.

• Flush with 15–30 mL water between meds.

• Flush with 30 mL after the last med.

• Clamp the tube for 30–60 minutes to allow absorption.

• Reconnect suction after that time (if ordered).

Before giving any fluid or meds into NG

Check tube placement (per facility policy):

• Aspirate stomach contents and assess pH (should be ≤5).

• Confirm X-ray before first use if newly inserted.\

• Assess bowel sounds – ensures GI system is functioning.

• Confirm residual volume – excessive residual = delayed gastric emptying (hold feed/meds if high).

• Position patient: HOB 30–45° (semi-Fowler’s) to prevent aspiration.

Why position patient into semi-fowlers?

HOB 30–45°

To prevent aspiration, medication errors, and complications (e.g., administering into lungs or obstructed bowel)

Flushing Volumes

Use sterile or purified water (depending on policy and patient condition):

• Before first medication: 15–30 mL

• Between medications: 10–15 mL

• After last medication: 30 mL
  (Adjust if fluid restricted—check order.)

Fluid types

• Sterile water for immunocompromised or ICU patients.

• Tap water may be acceptable for stable adults (per PMH policy).

Administration Method

• Remove plunger and allow meds to flow by gravity, or

• Use the piston gently if needed for thick suspensions (do not force).

• Never use IV tubing or pressure to push meds.

Combining Free Water Flushes

with medication times to reduce extra fluid admin steps, as long as total prescribed water volume is met.
Example: if ordered “120 mL free water q4h,” and you’re giving meds at that time, count the pre, between, and post flushes toward that total.

If the Tube is Clogged

• Stop and do not force.

• Try flushing with warm water, gently alternating push-pull with syringe.

• If not cleared, use enzyme-based declogging agent (e.g., pancreatic enzyme and sodium bicarbonate).

• If still blocked, notify provider or charge nurse—tube may need replacement.

Medication Forms

OK to give:

• Liquid medications (preferred).

• Crushed tablets that are safe to crush (mix with 15–30 mL water).

• Dissolved powders designed for enteral use.

Do NOT give

• Enteric-coated, sublingual, or extended-release (SR, XR, CR, LA) tablets.

• Buccal meds or capsules containing beads that can clog tube.

• Any med that changes appearance or consistency when crushed (check “Do Not Crush” list).

If unsure → check with pharmacy before giving.

Each step (placement, assessment, flushing, correct form) is to prevent:

• Aspiration (from improper placement or lying flat)

• Tube blockage (from crushed or sticky meds)

• Medication errors (from giving incompatible or unabsorbable forms)

• Altered drug absorption (if feed not paused appropriately)