Nasogastric Tube Drug Instillation
Besides providing an alternate means of nourishment, a nasogastric (NG) tube allows direct instillation of medication into the GI system of patients who can’t ingest the drug orally. Before instillation, the patency and positioning of the tube must be checked carefully because the procedure is contraindicated if the tube is obstructed or improperly positioned, if the patient is vomiting around the tube, or if the patient’s bowel sounds are absent.
Oily medications and enteric-coated or sustained-release tablets or capsules are contraindicated for instillation through an NG tube. Oily medications cling to the sides of the tube and resist mixing with the irrigating solution, and crushing enteric-coated or sustained-release tablets to facilitate transport through the tube destroys their intended properties.
Equipment
Patient’s medication administration record and medical record ▪ prescribed medication ▪ towel or linen-saver pad ▪ 50- or 60-mL piston-type catheter-tip syringe ▪ two 4″ × 4″ gauze pads ▪ pH test paper ▪ gloves ▪ diluent ▪ cup for mixing medication and fluid ▪ spoon ▪ 50 mL of water ▪ Optional: mortar and pestle, clamp.
For maximum control of suction, use a piston syringe instead of a bulb syringe. The liquid for diluting the medication can be juice, water, or a nutritional supplement.
Preparation of Equipment
Gather equipment for use at the bedside. Liquids should be at room temperature. Administering cold liquids through an NG tube can cause abdominal cramping. Although this isn’t a sterile procedure, make sure the cup, syringe, spoon, and gauze are clean.
Implementation
Verify the doctor’s order.1
Avoid distractions and interruptions when preparing and administering the medication to prevent medication errors.2
Compare the medication label to the order and verify that the medication is correct.3
Check the expiration date on the medication; don’t give if the drug is expired.3
Check the patient’s medical record for an allergy to the prescribed medication. If an allergy is present, don’t administer the medication and notify the doctor.3
Discuss any unresolved concerns you may have with the patient’s doctor.
If the prescribed medication is in tablet form, crush the tablets with a mortar and pestle to ready them for mixing in a cup with the diluting liquid. Request liquid forms of medications, if available.
Bring the medication and equipment to the patient’s bedside.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
If the patient is receiving the medication for the first time, inform the patient about any clinically significant adverse reactions or other concerns related to the new medication.3
Explain the procedure to the patient, if necessary, and provide privacy.
Make sure that the medication is being administered at the proper time, in the prescribed dose, and by the correct route.3
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