Medication Administration via Gastrostomy Button with Syringe

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Considerations:

  • Always consult the ENFit/enteral syringe manufacturer instructions for use. These are guidelines for general filling practices and do not supersede the manufacturer recommendations.
  • Be sure to take steps to ensure student privacy when performing the procedure.
  • The most significant risk with giving liquids via a gastrostomy button is possible aspiration into the lungs, be sure the student is positioned properly with the head elevated at least 30 degrees.
  • Encourage the student to assist in the procedure as much as they are able to help the student learn self-care skills.
  • Verify with the health care provider if gastrostomy button placement should be verified prior to medication administration. And if so, what method the health care provider would like used to verify placement.

Supplies:

  • Gastrostomy button replacement “kit”:
    • Replacement gastrostomy button
    • 6-mL luer slip syringe
    • Medical tape
    • Water-based lubricant
  • Prescribed medication
  • ENFit/enteral Syringe(s)
  • Measuring devices (i.e. medicine cup)
  • Extension set, if applicable
  • Warm tap water, if prescribed
  • Towel or washcloth
  • Non-sterile gloves
  • Student’s Individualized Health Care Plan (IHCP) and  health care provider’s order
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Procedure:

  1. Review the student’s IHCP and health care 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 their level of understanding
  5. Encourage the student to assist in the procedure as much as they are 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:
  10. The right student
  11. The right medication
  12. The right dose
  13. Being given at the right time
  14. Being given by the right route
  15. Being given for the right reason
  16. Ensure that the medication has not expired
    1. If medication has expired do not administer it, follow up with parent/guardian and health care provider
  17. Review student’s allergy status
  18. Position student either sitting or supine with head up at least 30 degrees
  19. The most significant risk with giving liquids via a gastrostomy button is possible aspiration into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees
  20. Put a towel or washcloth under student’s gastrostomy button
  21. Put on gloves
  22. Observe abdomen for signs of malposition or obstruction of gastrostomy button such as abdominal distention
  23. If student has abdominal distention do not administer the medication, instead contact parent/guardian and health care provider
  24. Review the six rights of medication administration again to be sure it is:
  25. The right student
  26. The right medication
  27. The right dose
  28. Being given at the right time
  29. Being given by the right route
  30. Being given for the right reason
  31. Pour the pre-medication and post-medication water flushes in separate measuring devices (i.e. medicine cups)
  32. Draw up prescribed pre-medication and post-medication water flushes from the measuring devices into ENFit/enteral syringes and set aside
  33. If the extension tubing is not already primed: (If extension tubing is primed, move to the next step.)
    1. Pour about 10 mL of water into a measuring device
    2. Draw up at least 5 mL of water into ENFit/enteral syringe
    3. Attach an ENFit/enteral syringe to extension tubing
    4. Ensure that the clamp is open
    5. Flush at least 5 mL of water through extension tubing
    6. Clamp extension tubing
    7. Remove the ENFit/enteral syringe
    8. Set extension tubing aside
  34. Prior to putting the tip of the ENFit/enteral syringe into the measuring device, cycle the ENFit/enteral syringe  
  35. Cycle the ENFit/enteral syringe by pulling and pushing the plunger back and forth
  36. Insert the ENFit/enteral syringe into the measuring device containing the medication
  37. Gently pull on the ENFit/enteral syringe plunger to fill the ENFit/enteral syringe with the prescribed dose
  38. Remove the air bubbles and then flick the ENFit/enteral syringe or wipe off the end of the ENFit/enteral syringe to remove excess medication from the moat tip (if using low dose ENFit/enteral syringe)
    1. In the event that there is excess fluid in the “moat” of the ENFit/enteral syringe tip, it is recommended to tap/flick/wipe that excess fluid away 
  39. Set medication ENFit/enteral syringe aside
  40. Remove plug from gastrostomy tube/button
  41. Attach the extension tube filled with water to the G-tube/Button
  42. Twist the ENFit/enteral syringe with 15 mL or the prescribed amount of pre-medication water flush onto the medication/feeding port
  43. Open clamp on the extension tube
  44. Gently push the ENFit/enteral syringe to administer the water flush
  45. Re-clamp extension tubing
  46. Twist the ENFit/enteral syringe to unlock the connection
  47. Twist the ENFit/enteral syringe containing the prescribed medication dose onto the medication/feeding port
  48. Open the clamp
  49. Gently push the ENFit/enteral syringe plunger to administer the medication
  50. Re-clamp extension tubing
  51. Twist the ENFit/enteral syringe to unlock the connection
  52. Twist the ENFit/enteral syringe with 15 mL or prescribed amount of post-medication water flush onto the medication/feeding port
  53. Open clamp on extension tubing
  54. Flush the prescribed amount of water, being sure the medication gets down in the tube
  55. Re-clamp extension tubing
  56. Remove extension tubing
  57. Insert plug into G-tube/Button
  58. Remove gloves
  59. Wash hands
  60. Secure medication
  61. Wash the ENFit/enteral syringe and extension tubing with soap and warm water and put in home container
    1. Check student’s IHCP and/or health care provider’s orders regarding the length of time to reuse any of the equipment
  62. Document medication administration on student’s medication administration record
  63. Follow up with parents/guardian and health care provider, as needed

Some students may use medicine straws and bottle fill caps. Below are the instructions for use of these devices.

Drawing up the medication using an ENFit Medication Straw:

  1. Connect the ENFit/enteral syringe to the medication straw
  2. Put the straw into the medication bottle/medication cup
  3. Draw up the prescribed medication dose
  4. Take the straw off the ENFit/enteral syringe and gently tap the straw to remove any medication
  5. When using a low dose tip ENFit/enteral syringe, make sure there are no air bubbles in the ENFit/enteral syringe
    1. During the filling process, carefully tap or flick the ENFit/enteral syringe to remove the air bubble
  6. Remove the medication straw
  7. Continue to medication administration procedure

Filling the ENFit/enteral syringe using a Bottle Fill Cap:

  1. Cycle the ENFit/enteral syringe by pulling and pushing the plunger back and forth
  2. With the ENFit fill cap attached to the medication bottle, connect the ENFit/enteral syringe to the top of the bottle fill cap
  3. Gently turn the medication bottle upside down
  4. Pull and push back the ENFit/enteral syringe plunger to cycle it once or more
    1. This helps to eliminate air bubbles
  5. Withdraw the prescribed medication dose
  6. When ready, return the bottle to its upright position and remove the ENFit/enteral syringe
  7. Continue to medication administration procedure

References:

American Society for Parenteral Enteral Nutrition (ASPEN). (n.d.). Preparing and administering medications using ENFit®: Procedure for use in home setting. Retrieved June 22, 2023, from https://www.nutritioncare.org/WorkArea/DownloadAsset.aspx?id=4646

Applied Medical Technology, Inc. (2022). MiniOne education guide. Retrieved June 22, 2023, from https://www.appliedmedical.net/wp-content/uploads/2022/05/MiniONE_EDU_English_C-3974-M.pdf

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 Mercy Kansas City. (2016, October 4). Preparing and administering medication using ENFit. Procedure for the home setting. . Retrieved June 22, 2023, from https://www.youtube.com/watch?v=DgT55OvgLRo

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

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

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