<< 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.
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
Click on the photo to access the video.
- Check for authorization forms/record
- Medication Administration Form
- Medical provider
- Parent/guardian
- 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
- Ensure that the medication has not expired
- Explain the procedure to the student at his/her level of understanding
- Wash hands
- Gather equipment and place on clean surface
- 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
- Put a towel or washcloth under student’s gastrostomy tube
- Put on gloves
- 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
- Measure the medication and water in separate measuring device, i.e. cup
- Draw up medication in syringe
- Fill the extension tubing with water using a syringe with at least 5 cc or ml of water
- Open port on the gastrostomy access port
- Attach the extension tube filled with water to the access port
- Open medication port on the extension tube and insert syringe with medication
- Slowly push the plunger into barrel of syringe instilling all the medication into the tube
- Close clamp extension tube
- Detach the syringe from the extension tubing
- Draw up prescribed water into syringe and attach the extension tubing
- Open clamp
- Gently and slowly push the water into tubing until all water has gone into the tube
- Re-clamp extension tubing
- Detach syringe and cap access port
- Secure medication
- 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
- Remove gloves
- Wash hands
- Document medication administration on medication administration record
- 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