WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
OBSTETRICS AND GYNAECOLOGY
ENTERAL TUBES
ENTERAL MEDICATION ADMINISTRATION
Keywords: enteral medication, NGT, nasogastric, drug administration
AIMS
To administer medications through the nasogastric route safely within the hospital medication
administration guidelines.
To limit the occurrence of nasogastric tube (NGT) blockage.
KEY POINTS
1.
2.
3.
4.
5.
6.
1
Contact the Pharmacy Department for advice before proceeding.
Some fine bore feeding tubes may not be suitable for drug administration.
Administration of oral medications to patients via a nasogastric tube can be complicated due to
1
drug formulation, drug / nutrient interactions and characteristics of the tube.
Crushing tablets or opening capsules should be considered as a last resort. Liquid formulations
2
should be used whenever possible. Another route of administration may be appropriate.
Use syringes and administration sets marked specifically for oral / enteral administration (e.g.
3, 4
purple Vygon) for oral / enteral medication administration.
Do not crush:
Enteric coated (EC) medications
Modified release (MR, SR, LA, XL, CR, ER) medications
For determination of what medications can be crushed
 Contact Pharmacy
 MIMS Online
Cytotoxics.
EQUIPMENT
3
4
50-60mL purple oral / enteral syringe (Do not use a syringe smaller than 30mL to avoid
excessive pressure and tube rupture)
pH indicator strips
Tap water in a cup (boiled/ sterile water for immunocompromised women)
Prescribed medication
5
Personal protective equipment (includes disposable gloves )
Mortar and pestle.
3
PROCEDURE
1. Confirm the woman’s identity.
3
2. Prepare the medication.
5
3. Confirm the tube placement prior to administering the medication & document the aspiration
3
details (see Clinical Guideline O&G: Enteral Tubes: Nasogastric Tube Insertion).
3
1
4. Check the tube patency and flush with at least 10mL to 30mL of room temperature water
1
(boiled / sterile water should be used for immunocompromised women). Formula residue
must be removed thoroughly to prevent intraluminal mixing of nutrients and the medication;
this is one of the most common causes of tube blockage.
5. If the tablets must be crushed, ensure they are crushed into a fine powder, with the tablet
crusher or mortar and pestle if available, and mix well with water. Liquid medication must be
diluted before administration.
2014
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 1 of 2
1, 3
6. Connect the syringe to the end of the tube and administer using gravity flow.
7. If more than one medication is to be administered, flush between drugs with at least 10mL of
water to ensure that the drug is cleared from the tubing.
1, 3
8. Flush the tube with at least 15- 30mL of water following administration of the last medication.
3
9. Recommence feeds as required, or if on straight drainage, spigot the tube for one hour .
REFERENCES / STANDARDS
1.
Fremantle Hospital and Health Service. Nasogastric tube (NGT): Insertion and care of in adults: Procedure. Fremantle,
WA: FHHS. 2013.
2.
The Joanna Briggs Institute. Acute Care Practice Manual. JBI; 2014. Available from:
http://connect.jbiconnectplus.org
3.
Sir Charles Gairdner Hospital. Practice guideline No. 29: Nasogastric and nasojejunal tubes: SCGH. 2011.
4.
Department of Health Western Australia. Operational Directive 0443/13: Safe administration of oral, enteral, or
nebuliser solutions (use of oral syringes for administration of oral, enteral or nebuliser solutions). WA:
Department of Health; 2013.
5.
Slade S. Evidence summary: Nasoenteric feeding: Management. JBI. 2014:96-100.
National Standards – 1 Clinical Care; 4 Medication Safety
Legislation - Nil
Related Guidelines/ Policies – KEMH Clinical Guidelines: Section O&G: Enteral Tubes
Other related documents – Nil
RESPONSIBILITY
OGCCU / Pharmacy
Nursing & Midwifery Director OGCCU
Policy Sponsor
March 2009
Initial Endorsement
May 2014
Last Reviewed
January 2015
Last Amended
May 2017
Review date
Date Issued: March 2009
Date Revised: May 2014
Review Date: May 2017
Written by:/Authorised by: OGCCU
Review Team: OGCCU / Pharmacy
2014
Enteral Medication Administration
Obstetrics & Gynaecology
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 2 of 2