Administering

Medications via
Gastric tube
Gastric
tube
Medications that cannot be
crushed:
1. Enteric or other coated drugs (EC)
➢ Enteric coatings are designed to protect drugs from attack
by stomach acid or to protect the stomach from irritation by
the drug. Beyond the stomach the coating breaks down to
allow drug absorption.
➢ Enteric coated tablets should not be crushed as this
destroys the coating resulting in inactivation of drug or
increased risk of adverse effect.
Medications that cannot be
crushed:
2. Controlled, slow, or extended release drugs
➢ These products are formulated to allow a gradual
release of drug as the preparation passes down the GI
tract. This may enable less frequent dosing or minimise
side effects due to peak concentrations of drug in the
body. Crushing controlled release formulations may
destroy their controlled release properties resulting in
adverse effects and shortening duration of action.
Step-by-step guide for safe enteral medication

administration:
1. Establish the suitability of the route.
➢ Health care professionals who administer enteral
medications should determine the location of the
distal end of the feeding tube and should consult
with a pharmacist to ensure that the medication
will be properly dissolved and absorbed.
Step-by-step guide for safe enteral medication

administration:
2. Establish the suitability of the drug and the dosage form.
➢ ensure that the drug and the formulation are appropriate for enteral administration.

➢ For solid dosage forms, the staff can refer to the current “do not crush list”
➢ Nurses should consult with the pharmacist if they have questions or to see whether
liquid dosage forms are available and appropriate.
➢ The pharmacist can also contact the prescriber to switch to a product that is more
suitable for enteral tube administration if necessary.
Step-by-step guide for safe enteral medication

administration:
3. Prepare each drug separately.
➢ Each medication should be prepared individually so
that it can be administered separately.
Step-by-step guide for safe enteral medication

administration:
4. Open the capsules.
➢ Immediate-release gelatin capsules should be opened to remove the
powder or to crush the solid contents.
Step-by-step guide for safe enteral medication

administration:
5. Crush solid dosage forms.
➢ Whenever possible, the pharmacy staff should crush tablets into a fine
powder using a fully self-contained, pill-crushing device. This practice
prevents residue from one medication from being mixed with another
medication.
➢ Allergenic, cytotoxic, carcinogenic, or teratogenic drugs should be
crushed by a pharmacist under highly controlled conditions and only
when necessary.
Step-by-step guide for safe enteral medication

administration:
6. Dilute medications.
➢ The crushed drug, as well as liquid medications, should be diluted.
Purified (sterile) water is the preferred diluent for most drugs. Tap
water is not advised, because it often contains chemical contaminants
(e.g., heavy metals and medications) that might interact with the drug.
➢ The diluted medication should be drawn up into an oral syringe and
dispensed to the nursing unit ready for administration.
Step-by-step guide for safe enteral medication

administration:
7. Don’t mix medications with feeding formulas.
➢ Medications should not be added directly to the feeding
formula. Mixing a drug with a formula could cause drug–
formula interactions, leading to tube blockages, altered
bioavailability, and changes in bowel function.
Step-by-step guide for safe enteral medication

administration:
8. Flush.
➢ After the drug is delivered, the feeding should be stopped and
the tube should be flushed with at least 15 mL of purified
water before and after each medication is given.
Step-by-step guide for safe enteral medication

administration:
9. Administer each drug separately.
➢ Each medication should be given separately through the
feeding tube. A clean 30-mL or larger oral (non-Luer tip)
syringe should be used.
Step-by-step guide for safe enteral medication

administration:
9. Administer each drug separately.
➢ Each medication should be given separately through the
feeding tube. A clean 30-mL or larger oral (non-Luer tip)
syringe should be used.
❖ Know the action, side effects, nursing
considerations or whether medications
should be administered with or without food.
❖ Assess patient knowledge about medication
and the reason of administration
❖ Auscultate the abdomen
❖ Percuss and palpate the abdomen for
presence of tenderness
Nursing Diagnosis:
1. Knowledge Deficit
2. Risk for Injury
3. Impaired swallowing