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 catheter-tip 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

procedure download skill competency

med-gtube
Click on the photo to access the video.

  1. Check for authorization forms/record
    • Medication Administration Form
    • Medical provider
    • Parent/guardian
  2. 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
  3. Ensure that the medication has not expired
  4. Explain the procedure to the student at his/her level of understanding
  5. Wash hands
  6. Gather equipment and place on clean surface
  7. 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
  8. Put a towel or washcloth under student’s gastrostomy tube
  9. Put on gloves
  10. 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
  11. Pour prescribed amount of medication into medicine cup
  12. Fill the extension tubing with water using a syringe with at least 5 cc or ml of water
  13. Remove plunger from syringe
  14. Open port on the gastrostomy access port
  15. Attach the extension tube filled with water to the access port
  16. Attach syringe to the medication port on the extension tube
  17. Pour prescribed medication amount into syringe
  18. Elevate the syringe above the level of the stomach
  19. Open clamp on extension tubing and allow medication to slowly flow through extension tubing
  20. Close clamp extension tube
  21. Pour prescribed amount of water into medicine cup
  22. Pour prescribed amount of water into syringe
  23. Open clamp and allow water to allow water to slowly flow through extension tubing
  24. Clamp enteral tube and remove syringe
  25. Snap safety plug in place
  26. Secure medication
  27. 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
  28. Remove gloves
  29. Wash hands
  30. Document medication administration on medication administration record
  31. Follow up with parents/guardian and healthcare provider, as needed

Resources:

MIC—KEY LOW–PROFIILE GASTROSTOMY FEEDING TUBE: YOUR GUIDE TO PROPER CARE
http://www.mic-key.com/media/40679/r8201b_mic-key_care_guide_english.pdf

MIC Enteral Feeding Tubes and Accessories
http://www.kchealthcare.com/media/2886710/u4850_mic_enteral_tubes.pdf

Guidance and support to help you manage your gastrostomy tube (g-tube) Capsule Non-Balloon Mini ONE® Buttons
http://www.amtinnovation.com/pdf/AMT_NonBalloonPatientCare.pdf


References:

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Connecticut State Department of Education.

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 Reviewers:

The procedure list and video for this procedure were developed in collaboration with the Wisconsin Department of Public Instruction.

Bette Carr, MSN, RN, NCSN
School Nursing and Health Services Consultant
WI Department of Public Instruction

Teresa DuChateau, DNP, RN, CPNP
School Nurse Resource Coordinator
WI Public Health Association


Page last updated: October 1, 2015