Medication Administration - Enteral Tube

Medication Administration – Enteral Tube 

Purpose: 

To ensure safe and effective medication administration via enteral tubes for residents who require enteral nutrition or medication delivery. 

Procedure: 

I. Resident Positioning: 

• Place the resident in the proper position. If the resident is in bed, elevate the head of the bed to a 45-degree angle. 

II. Verifying Tube Placement: 

• Unclamp the tube and verify placement using one of the following methods: 

• Insert a small amount of air into the tube with a syringe and listen for gurgling sounds over the left upper quadrant of the stomach with a stethoscope. 

• Aspirate stomach contents with a syringe. 

• Never administer medications through a Miller-Abbott tube. Use a Dubhoff or Kangaroo tube. 

III. Preparing Medications: 

• Reclamp the tube to maintain a closed system while preparing medication. 

• Prepare each medication for administration separately: 

• Use a pill crusher if the order states to crush medications. 

• Crush tablets and dissolve in 10-15 ml of water or other appropriate liquid. Consult “Crush Guidelines” before crushing tablets. 

• Empty capsule contents into 10-15 ml of water or other appropriate liquid approved by the physician. 

• Dilute liquid medications with 10-15 ml of water, using up to 60 ml of water for highly concentrated solutions. 

IV. Administering Medications: 

• Administer each medication separately, flushing the tube with 10-15 ml of water after each dose. 

• Medications should never be added directly to the feeding solution. 

• Allow medication to flow down the tube via gravity. Gentle pressure with the plunger can only be used if there is a written physician order. 

• Flush the tube with 30 ml of water after all medications have been administered. Do not allow air to enter the tube. 

V. Order of Administration: 

• Administer liquid medications first. 

• Administer medications that need to be diluted next. 

• Reserve thick medications, such as antacids, for last. 

VI. Post-Administration: 

• Flush the tube with 30 ml of water and clamp the tube. 

• If the tube is attached to continuous feeding, resume feeding immediately. 

• Leave the head of the bed elevated for 30 minutes. 

• Leave the tracheostomy cuff inflated for 30 minutes if applicable. 

• Document any problems in the nursing notes. 

• Chart water on the I&O sheet if appropriate. 

• Clean the feeding syringe and return it to the bedside stand. Syringes are to be replaced every 24 hours. 

References: 

• Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

• State Operations Manual (SOM), CMS.