Administering Medication through Gastrostomy Tube via Gravity

Considerations:

• Be sure to take steps to ensure student privacy when performing procedure.
• The most significant risk with giving liquids via a gastrostomy tube is possible aspiration into the lungs, be sure the student is positioned properly with the head elevated at least 30 degrees.
• Encourage the student to assist in the procedure as much as they are able to help the student learn self-care skills.
• Verify with the health care provider if gastrostomy tube placement should be verified prior to medication administration. And if so, what method the health care provider would like used to verify placement.

Supplies:

• Gastrostomy button replacement “kit”: 
  • Replacement gastrostomy button
  • 6-mL luer slip syringe
  • Medical tape
  • Water-based lubricant
• Prescribed medication
• Measuring devices (i.e. medicine cups)
• 60-mL ENFit/enteral feeding syringe
• Extension set, if applicable
• Warm tap water, if prescribed
• Towel or washcloth
• Non-sterile gloves
• Student’s Individualized Health Care Plan (IHCP) and health care provider’s order
• Parent/Guardian Authorization Form

Procedure:

1. Review the student’s IHCP and health care provider’s order
2. Ensure proper documentation of parent/guardian authorization to administer medication
3. Position student to provide as much privacy as possible
4. Explain the procedure to the student at their level of understanding
5. Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills
6. Gather needed supplies and place on clean surface
7. Wash hands
8. If student will be administering medication, have student wash hands
9. Review the six rights of medication administration to be sure it is:
   1. The right student
   2. The right medication
   3. The right dose
   4. Being given at the right time
   5. Being given by the right route
   6. Being given for the right reason
10. If pills or capsules are to be given, check with a pharmacist or drug reference to verify the ability to crush tablets or open capsules
11. Ensure that the medication has not expired
    1. If medication is expired do not administer it, follow up with parent/guardian and health care provider
12. Review student’s allergy status
13. Position student either sitting or supine with head up at least 30 degrees
    1. The most significant risk with giving liquids via a gastrostomy tube is possible aspiration into the lungs, be sure the student is positioned properly with the head elevated at least 30 degrees
14. Put a towel or washcloth under student’s gastrostomy tube
15. Put on gloves
16. Observe abdomen for signs of malposition or obstruction of gastrostomy tube such as difference in external tube length compared to baseline measurements or abdominal distention
    1. Compare external tube length to tube length measurements obtained after initial placement of the tube, contact parents/guardian and health care provider if discrepancy in measurements
    2. If student has abdominal distention do not administer medication, instead contact parent/guardian and health care provider
17. Review the six rights of medication administration again to be sure that it is:
    1. The right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
18. Pour the pre-medication and post-medication water flushes in separate measuring devices (i.e. medicine cups)
19. Pour the prescribed amount of medication into measuring device and set aside
20. If the extension tubing is not already primed: (If extension tubing is primed, move to the next step.)
    1. Pour about 10 mL of water into a measuring device
    2. Draw up at least 5 mL of water into the ENFit/enteral syringe
    3. Attach the ENFit/enteral syringe to extension tubing
    4. Ensure that the clamp is open
    5. Flush at least 5 mL of water through extension tubing
    6. Clamp the extension tubing
    7. Remove the ENFit/enteral syringe
    8. Set the extension tubing aside
21. Remove plunger from 60-mL ENFit/enteral syringe
22. Remove the plug from the gastrostomy button/tube
23. Attach the extension tube filled with water to the g-tube button/tube
24. Attach 60-mL ENFit/enteral syringe to the medication port on the extension tube
25. Pour 15 mL or prescribed amount of pre-medication water flush into the ENFit/enteral syringe
26. Elevate the ENFit/enteral syringe above the level of the stomach
27. Open clamp on extension tubing and allow water to slowly flow through extension tubing
28. Re-clamp extension tubing
29. Pour prescribed medication amount into ENFit/enteral syringe
30. Elevate the ENFit/enteral syringe above the level of the stomach
31. Open clamp on extension tubing and allow medication to slowly flow through extension tubing
32. Re-clamp extension tubing
33. Pour 15 mL or prescribed amount of post-medication water flush into the ENFit/enteral syringe
34. Open clamp and allow water to slowly flow through extension tubing
35. Re-clamp extension tubing
36. Remove extension tubing
37. Insert plug in G-tube
38. Remove gloves
39. Wash hands
40. Secure medication
41. Wash the ENFit/enteral syringe and extension tubing with soap and warm water and put in home container
    1. Check student’s IHCP and/or health care provider’s orders regarding the length of time to reuse any of the equipment
42. Document medication administration on student’s medication administration record
43. Follow up with parents/guardian and health care provider, as needed

References:

Boullata, J. I., Carrera, A. L., Harvey, L., Escuro, A. A., Hudson, L., Mays, A., McGinnis, C., Wessel, J. J., Bajpai, S., Beebe, M. L., Kinn, T. J., Klang, M. G., Lord, L., Martin, K., Pompeii-Wolfe, C., Sullivan, J., Wood, A., Malone, A., Guenter, P., & ASPEN Safe Practices for Enteral Nutrition Therapy Task Force, American Society for Parenteral and Enteral Nutrition. (2017). ASPEN safe practices for enteral nutrition therapy [Formula: see text]. JPEN. Journal of parenteral and enteral nutrition, 41(1), 15–103. https://doi.org/10.1177/0148607116673053

Children’s Hospital St. Louis. (2015, May). Gastrostomy tubes home care manual (corpak, foley catheter, genie, malecot, mic-G). Retrieved June 22, from https://www.stlouischildrens.org/sites/legacy/files/Gastrostomy%20Tubes%20Home%20Care%20Manual.pdf

Lynn, P. (2019). Administering medications via a gastric tube. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 61-63).

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 21.2 administering medications through a feeding tube. In Clinical nursing skills and techniques. (10th ed.). (pp. 613-618). St. Louis, MO: Elsevier.
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Acknowledgment of Reviewers:

Angie Bulmahn, MSN, RN, NCSNzzz
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last updated: Video December 22, 2023; February 15, 2024
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The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.

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