Medication Administration via Gastrostomy Tube with Syringe

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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
Syringe/s
Measuring cups
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 device, i.e. cup
  15. Draw up medication in syringe
  16. Fill the extension tubing with water using a syringe with at least 5 cc or ml of water and clamp the tube
  17. Open port on the gastrostomy access port
  18. Attach the extension tube filled with water to the access port
  19. Open medication port on the extension tube and insert syringe with medication
  20. Open the clamp and slowly push the plunger into barrel of syringe instilling all the medication into the tube
  21. Close clamp extension tube
  22. Detach the syringe from the extension tubing
  23. Draw up prescribed water into syringe and attach the extension tubing
  24. Open clamp
  25. Gently and slowly push the water into tubing until all water has gone into the tube
  26. Re-clamp extension tubing
  27. Detach syringe and cap access port
  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.