Medication Administration via Gastrostomy Tube by Gravity

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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.

Supplies:

  • Prescribed medication
  • 60ml feeding syringe
  • Extension set, if applicable
  • Warm tap water, if prescribed
  • Towel or wash cloth
  • Non-sterile gloves
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order
This video was developed in partnership with the Wisconsin Department of Public Instruction
Procedure Download
Skill Competency Download

Procedure:

  1. Position student to provide as much privacy as possible
  2. Explain the procedure to the student at his/her level of understanding
  3. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  4. Gather needed supplies and place on clean surface
  5. Wash hands
  6. If student will be administering medication, have student wash hands
  7. Check for authorization forms/record
    • Medication Administration Form
    • Medical provider
    • Parent/guardian
  8. Check for the Five Rights
    • Right student
    • Correct time
    • The medicine container matches authorization forms and medication administration record
    • The dose on medication container matches authorization form and records
    • The medication is in the correct route as identified on medication container, authorization forms and medication record
  9. Ensure that the medication has not expired
  10. 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
  11. Put a towel or washcloth under student’s gastrostomy tube
  12. Put on gloves
  13. 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
  14. Measure the medication and water in separate measuring devices, i.e. cup
  15. Fill the extension tubing with water using a syringe with at least 5 cc or ml of water and clamp the tube
  16. Remove plunger from syringe
  17. Open port on the gastrostomy access port
  18. Attach the extension tube filled with water to the access port
  19. Attach syringe to the medication port on the extension tube
  20. Pour prescribed medication amount into syringe
  21. Elevate the syringe above the level of the stomach
  22. Open clamp on extension tubing and allow medication to slowly flow through extension tubing
  23. Close clamp extension tube
  24. Pour prescribed amount of water into syringe
  25. Open clamp and allow water to allow water to slowly flow through extension tubing
  26. Clamp enteral tube and remove syringe
  27. Snap safety plug in place
  28. Secure medication
  29. 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
  30. Remove gloves
  31. Wash hands
  32. Document medication administration on medication administration record
  33. Follow up with parents/guardian and healthcare provider, as needed

References:

Bowden, V. R., & Greenberg, C. S. (2016). Pediatric nursing procedures (eBook) (4th Edition). Philadelphia: Wolters Kluwer Health.

Connecticut State Department of Education.  (2012). Clinical Procedure Guidelines for Connecticut School Nurses.  Available at:  http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Kimberly Clark. (2010). MIC-KEY care and usage guide.  Available at: www.mic-key.com/resources/mic-keystar-care–usage-guide.aspx

Pavia, M.  (2012).  National Institute for Health and Clinical Excellence (NICE). Infection. Prevention and control of healthcare-associated infections in primary and community care. London (UK): National Institute for Health and Clinical Excellence (NICE), 47 p.

Acknowledgment of Update Reviewer:

Marcy Weidkamp, APNP
Pediatric Gastroenterology
American Family Children’s Hospital

Acknowledgment of Initial Reviewers:

Bette Carr, MSN, RN, NCSN
School Health Associates
Co-Owner/Consultant

Teresa DuChateau, DNP, RN
School Health Associates
Co-Owner/Consultant

Page last reviewed: September 17, 2021
Page last updated: September 17, 2021

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.