Giving Medications Through a Feeding Tube

Giving medications through a feeding tube isn't like popping a pill in your mouth, obviously. You'll need supplies that other people don't need. And I'll even tell you how to stay organized so that you don't make a mistake.

Often times the pharmacy will supply you with one or two if you need one for a prescription. Sometimes meds come in a box that includes syringes. I'm sure they're just trying to keep costs down by only giving you a couple of syringes for a bottle of medicine that will last 30 days. But unless the writing on the syringe is blue, you can be sure that you will only be able to wash a syringe a few times before the rubber part swells up and you can't use the syringe anymore without it breaking on you. Because I need more than what we get from the pharmacy, or what comes in the box, I get a prescription for new ones every month. I'm able to get a few of them delivered from the same company that supplies us with his G-tube and extensions. Nick's insurance doesn't pay for very many, though. So when I need even more, I buy them from the pharmacy. I just warn them in advance if I need a lot of them. You can also order oral syringes online from places like Amazon.

I only know about oral syringes, so I can't speak of syringes with needles (which I'm pretty sure you need a prescription for). You can get oral syringes in many sizes. I happen to use: 1ml, 3ml, 5ml, 10ml, and 35ml or 60ml.

If you are giving a very small dose, like 0.9 ml, you should definitely use the 1ml syringe. It will be the most accurate. I use the 35ml or 60ml for giving meds that need to be mixed with a lot of water and put through the feeding tube. I just close off the medicine port and twist the large syringe into the feeding port. Again, make sure you close the medicine port or you'll have a big mess. Ask me how I know! I also keep my thumb on that little bugger (med port) just to make sure it doesn't open up on me. People often refer this method as bolus feeds, usually reserved for giving a patient formula or extra fluids. But it's definitely easier to give meds mixed with lots of water using this method rather than sucking up syringe full after syringe full with a smaller syringe.

To give meds through the large syringes, I keep the syringe as low as I need to be in order to administer the medication slowly. I don't just dump it in there. And I use room temperature water. Never cold, and certainly not too warm. Cold water will give him stomach cramps.

And as if having different sized syringes isn't enough, you can also get different tips: One type of syringe is called a luer-lock syringe. It has a small center tip, with a screw-type outer tip. I don't care for these syringes for two reasons: first and foremost, you can't use them with the little rubber bottle stoppers, AKA adapters. (I go into further explanation of adapters below.) The tip of a luer-lock syringe doesn't fit into the hole of a bottle adapter. You'd need to use something like a catheter adapter in the top of the stopper first (see below), then screw the luer-lock syringe onto the catheter adapter. I actually do use this method for one of Nick's meds (also described below).

The second reason why I don't care for the luer-lock is that they don't seal nicely to the medicine port of the feeding tube, at least the ones that I have don't. The medication leaks out. So for the one med that I do use the luer-lock syringe with, I attach a 35ml syringe to the tube and squirt the med into the larger syringe, let it drain down, and flush with the meds he's going to get in the 35ml syringe at that time of day anyhow. You could also use the catheter adapter to put the med through the medicine port with a luer-lock syringe. You'll definitley get a nice tight fit with the adapter.

Tip: I find that the 35ml and 60ml syringes often don't like to stay put in the feeding port, especially when they're new. The tips of these syringes are slippery and they fall out easily. When this happens, I just scuff the part of the syringe that goes in the port with an emery board. Works like a charm.

Another type of syringe tip is just a straight, or slip tip. The length and diameter of the tips can vary. If you're putting it through the tube, make sure the tip is long enough and wide enough to seal nicely to the medicine port. The ones that the pharmacy give you should be fine for the 1ml. Larger ones may very well end up being luer-lock syringes. If you're ordering from a medical supply company, just tell them what you're using them for, and be sure to specify the type of tip you want.

Yet another type of tip is the catheter tip. It is longer, and is found on the 35ml and 60ml syringes. These larger syringes don't fit into the medicine port. You use them in the feeding port for venting (using the fatter, venting tube), administering meds that have been mixed with a lot of water, and gravity feeding (formula and water).

Tip: to use a luer-lock syringe in the rubber medication stoppers (adapter), use a catheter adapter. Just put the adapter in the stopper, then screw on the syringe.

I can't imagine trying to measure out liquid meds using a syringe if I didn't have these adapters. Amazon sells them at a great price, and it even comes with a 10 ml syringe with the blue writing on it. These syringes with blue writing last a looong time.

To use the adapter, you simply replace the regular cover of the bottle with the adapter, stick the syringe in the hole, tip and measure. If you're using a small syringe, especially the 1ml syringe, you may have to draw it up, flush it back in, and repeat until you get all the air our of the syringe.

Being organized will not only save you time and get you into a routine so that you will be able to measure medications quickly, it will also help you prevent mistakes.

Nick has a whole bunch of meds. A couple of them need to be kept in the refrigerator, but the rest of them are kept in the cabinet. I use a hard plastic tote that I found in the craft isle at Walmart to keep meds, syringes, pill crusher, pill cutter, a pencil and a calendar in. This way I can just grab the tote, and get to work when it's time to do meds.

You can also buy a lock box to keep meds in if safety is a concern. Amazon has a small variety of lock boxes at very reasonable prices. Some are simply difficult to open, others actually have a combination lock on them.

For years, I didn't use a pill organizer. Then one day they were giving them away for free at the pharmacy. Now I'd hate to be without one. It's a great way to make sure you don't miss a dose, and also make sure you don't give too much. Just lay out a weeks worth of pills and you're good to go. And you can find all kinds of pill organizers. They even have them for giving doses several times per day.

If you have more than one medicine bottle that looks same (same size and color), ask the pharmacist to put one in a different sized bottle. You could also buy large, colored stickers and use the stickers to differentiate the bottles that way. Just don't cover up any important instructions, including the refill number. If it is a pill bottle, you could also use a permanent marker and write the first letter of the name of the medication.

Another way to not confuse medications when it is a liquid would be to use two different types of syringes on them, keeping a catheter adapter in one of them. I use the adapters that you put in the top of the bottle, tip, and measure. But for one of Nick's liquid meds, I insert a catheter adapter into the bottle adapter and leave it there so I have to use a luer-lock syringe on that bottle, and a regular straight tip syringe tip on the other bottle. This way I know which med is which by just glancing at them, and I'm sure to never confuse one med for the other.

My morning routine: I measure out all the meds and put them in my little basket. I make sure I have the baby bottle with water in it, a 5 cc syringe, a 35 cc syringe, and the feeding tube.

Sometimes I'll fit in as much liquid medicine into the tube as I can before I even hook it up to Nick's Mic-Key button. At the very least, the tube is filled with water, not air. I start with liquid meds, flush once, and then go on to the meds that I've crushed and put into a syringe. Use as big a syringe as you need when flushing through crushed meds in order to be able to add enough water so that the tube doesn't clog. I like to give Nick his liquid meds first and flush once so that if the tube happens to get clogged with the powdered meds, at least I've flushed in the liquid meds into his stomach.

A little more about crushed and powdered meds: Don't try to put through too much at once in the syringe. I dump it right from the pill crusher into the syringe and use at least a 5 cc syringe. One of his meds is a powder inside a capsule. I just open the capsule and put it in the medicine crusher. Then I dump it into the syringe. I then suck up almost a syringe full of water leaving a little bit of air in the syringe so that I can shake it and get off any powder that's stuck to the side or in the tip. After I push the medicine and water mixture into the feeding tube, I flush it with water a couple of times using the same syringe. This gets the last little bit of medicine out of the syringe.

When the feeding tube gets clogged with meds: I never really have a problem with tubes getting hopelessly clogged anymore. If the powder does get stuck when flushing it through the tube, first I look where where the clamp for the tube is and straighten out the kink. If that doesn't fix things, I look for a kink somewhere else in the tube. If things really get stuck, I'll try sucking a little bit back into the syringe and try again. When all else fails, I just unhook the feeding tube and dump everything into a cup. Add a little more water, suck it up into the syringe and try again. Then I add some more water to the cup to get the residual medicine that will inevitably be left in there.

After giving Nick the crushed pill and powdered medicine, I still one more med that needs to be mixed with a little bit of water. This particular med sticks to the plastic tubing, adding water to it ensures that the majority of it makes it into his stomach. I use a 30 cc syringe in the medicine port for this one. I give him what I've mixed with water, then swirl a little water in the cup and put that in as well, flushing with a bit more once the syringe is empty. It all, he gets 3 - 4 ounces of water with his meds in the morning.