Medication Administration via Gastrostomy Button by Gravity

<< DIGESTIVE

Considerations:

  • Be sure to take steps to ensure patient 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 head elevated at least 30 degrees
  • Encourage the student to assist in the procedure as much as he/she is able to help the student learn self-care skills.
  • Verify with healthcare provider if gastrostomy tube placement should be verified prior to medication administration. And if so, what method the healthcare provider would like used to verify placement.

Supplies:

  • Gastrostomy button replacement “kit”:
    • Replacement gastrostomy button
    • 6 mL luer tip syringe
    • Medical tape
    • Water based lubricant
  • Prescribed medication
  • 60-mL ENFit/enteral syringe
  • Extension set, if applicable
  • Warm tap water, if prescribed
  • Towel or wash cloth
  • Non-sterile gloves
  • Student’s Individualized Health Plan (IHP) and healthcare provider’s order
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Procedure:

  1. Review the student’s IHCP and healthcare 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 his/her level of understanding
  5. Encourage the student to assist in the procedure as much as he/she is 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:
    • The right student
      • The right medicadtion
      • The right dose
      • Being given at the right time
      • Being given by the right route
      • Being given for the right reasons
  10. If pills or capsules are to be given, check with pharmacist or drug reference to verify the ability to crush tablets or open capsules
  11. Ensure that the medication has not expired
    • If the medication has expired do not administer it, follow up with parent/guardian and healthcare provider
  12. Review student’s allergy stauts
  13. Position child either sitting or supine with head up at least 30 degrees
    • 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 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
    • Compare external tube length to tube length measurements obtained after initial placement of the tube, contact parents/guardian and healthcare provider if discrepancy in measurements
    • If student has abdominal distention do not administer the medication, instead contact parent/guardian and healthcare provider
  17. Review the six rights of medication administration again to be sure that it
    • The right student
    • The right medication
    • The right dose
    • Being given at the right time
    • Being given by the right route
    • Being given for the right reason
  18. Pour the pre-medication and post-medication water flushes into 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)
    • Pour about 10 mL of water into a measuring device
    • Draw up at least 5 mL of water into ENFit/enteral sryinge
    • Attach the ENFit/enteral syringe to extension tubing
    • Ensure the clamp is open
    • Flush at least 5 mL of water through the extension tubing
    • Clamp the extension tubing
    • Remove the ENFit/enteral syringe
  21. Set the extension tubing aside
  22. Remove plunger from 60-mL ENFit/enteral syringe
  23. Open port on the gastrostomy access port
  24. Remove the plug from gastrostomy tube
  25. Attach the extension tube filled with water to the access port
  26. Attach 60-mL ENFit/enteral syringe to the medication port on the extension tube
  27. Pour 15 mL or prescribe amount of pre-medication water flush into the ENFit/enteral syringe
  28. Elevate the ENFit/enteral syringe above the level of the stomach
  29. Open clamp on extension tubing and allow water to slowly flow through extension tubing
  30. Re-clamp extension tubing
  31. Pour prescribed medication amount into ENFit/enteral syringe
  32. Elevate the ENFit/enteral syringe above the level of the stomach
  33. Open clamp on extension tubing and allow medication to slowly flow through extension tubing
  34. Re-clamp extension tube
  35. Pour 15 mL or prescribed amount of post-medication water flush into the ENFit/enteral syringe
  36. Open clamp and allow water to allow water to slowly flow through extension tubing
  37. Re-clamp enteral tube
  38. Remove extension tubing
  39. Insert plug into G-tube
  40. Snap safety plug in place
  41. Wash syringe and extension tubing with soap and warm water and put in home container
    • Check with your school nurse about the length of time to reuse any of the equipment
  42. Remove gloves
  43. Wash hands
  44. Secure medication
  45. Document medication administration on medication administration record
  46. Follow up with parents/guardian and healthcare 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.

Page last reviewed: February 18, 2025
Page last updated: February 18, 2025

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.