Do you administer medications through a g-tube? Read all about it here. If you’re new at this, hopefully this blog will help you to feel more comfortable with the task. If you’re a veteran, maybe you’ll pick up something new.
I also recommend that you read Prescription Medications: Avoid Mistakes and Get Organized.
Syringes: When you have liquid medications, syringes are handy little buggers. Even if you’re not giving meds through a feeding tube. You can measure a medication with perfect accuracy, and you don’t have to worry about spilling it. You can also measure out a medication in advance, and even take pre-measured meds with you if you’re not going to be home when it’s time to take a med.
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.
Pill crushers: Word of caution: don’t buy a pill crusher that has the threads on the inside of the crusher if you need to put the crushed pill in a syringe. This has to be the dumbest design I’ve ever seen. The crushed pill just gets stuck in the threads.
Regular Pill Crusher
I’m sure there are many reasons why pills need to be crushed. For us, Nick gets his med through the feeding tube, so his meds need to be liquid or crushed to a fine powder.
The regular crusher that we have actually comes to a dull point inside the little well. This helps a lot for those semi-hard pills. You don’t need to turn it as hard to crush the pill. It also has a little storage compartment in the lid for keeping extra pills. The one thing I don’t like is that the powder usually gets stuck to the bottom of the crusher a little, and I need to loosen it in order to pour it into a syringe. I don’t know if this happens with all pill crushers. I’ve been using this same one for years.
Cutter and Hard Pill Crusher
One of his pills is extremely hard and I’ve actually cracked a pill crusher trying to crush it. Then I discovered that they make pill crushers with serrated teeth specifically for crushing these little buggers. I’d imagine if you had a large, hard pill, you should cut it one or two times first, so that you don’t break the crusher. This serrated crusher doesn’t crush pills into a fine powder though. So after I use the serrated crusher, I transfer the crushed med to a regular crusher and crush it up to a fine powder. This way the med goes through the tube easily. Oh, and this serrated tooth crusher has the threads on the inside of the crusher, so I’d need to transfer the powder to my regular pill crusher before putting it into a syringe anyhow.
Pill cutters: The crusher with serrated teeth that I use is actually a pill cutter as well. I’ve used many different pill cutters, and this one has definitely held up the longest. You can see a picture of it just above (it’s red). Click on the picture and it will bring you to this item on Amazon. We bought ours years ago and hopefully the quality is just as good now as it was then. When I looked this item up on Amazon, it received a poor review. But the person was trying to crush a large pill. I would cut a large pill first, and crush half at a time. I’ve never had a problem with it when crushing small pills.
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.
Catheter Adapter
Catheter adapters: Maybe not quite intended for what I use them for, these catheter adapters come in very handy if you’re trying to measure a liquid med and you only have a luer-lock syringe. Just put the adapter in the top of the bottle adapter and screw the syringe onto the catheter adapter.
Storage Box or Basket 
: 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.
Pill organizer: 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.
After you measure the meds: As I measure each med, rather than just putting the syringes on the counter, I place them in a little hard plastic basket. That way I can bring the meds wherever I need to go, and I can wash it afterwards.
Need water for flushing meds through a feeding tube? Nick’s meds go though the feeding tube, and I use a baby bottle to hold the water I need for administering his meds. A baby bottle is particularly handy for me, not only because I don’t spill the water when I’m not using it (I give him some meds while he’s in his bed, so there’s no hard surface to place the water on), but also because he gets Miralax, which needs to be mixed with water. I can just put it in the bottle and shake it.
Don’t confuse one medication with another when the bottles look alike.: 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.
Here’s my biggest tip on this subject: when putting meds through the medicine port with a syringe, keep your thumb tightly clamped on the feeding port! If there’s a kink in the tube somewhere, you’ll blow out that feeding port when you flush the syringe. You can imagine what a mess that makes, not to mention that now you can’t be sure how much of a med made it into the stomach if you already had meds in the tube before it blew out.
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.
In the past, I’ve found that generic acetaminophen tablets dissolve better than brand name Tylenol. But if you really want to use the brand name, crush it up in a pill crusher first. The large tablets most definitely need to be administered with the large 35 cc or 60 cc syringe though the feeding port.
I always refill prescriptions as soon as insurance will allow. The exception to this would be if a prescription expires within 30 days of being filled (not within X days of being opened). Why? Who knows what could happen that creates a situation where you can’t get to the pharmacy to pick up a prescription on time. Illness, family emergency, weather, vacations, even spilling medications or losing them. I’ve had bottles of pills get blown off the counter into a pan of water in the sink on a warm, windy day! If you have extra on hand, you have some time to play with.
I always bring all of Nick’s medications with me when he goes to the Emergency Room or is admitted to the hospital. I know at this point that his prescriptions are correct. I don’t have that control when he’s in the hospital. Not to mention that some of his medications aren’t that common, and rarely does the hospital staff give him his meds on time. It’s true. He’s due for meds at 7 am. The few times I’ve left it up to the hospital staff to get his medications, he’d get some at 7, some at 8:15, some at 9. He’s even gone a whole day without one that he’s supposed to get twice per day! If you have any medications that need to be refrigerated, the hospital pharmacy will probably need to take it and repackage it into their own bottle and you will have to ask for that particular medication from the nurse. But she will bring it to you, and you can still measure it and administer it yourself.
If you find that you just can’t get the syringes you have to attach securely to the medicine port, you can use a catheter adapter. It will fit nice and snug into the feeding port, but you’ll also need a luer-lock syringe, not a slip tip syringe for this method.
As mentioned earlier, syringes with blue writing are much more durable than syringes with black writing. You can wash the blue ones over and over again before the rubber part swells up and breaks.
The absolute best stuff I have ever used to protect the skin around the G-tube is Calmoseptine Ointment. One of the uses listed on the manufacturer’s web site is for the stoma site. I keep a tube of it right in the little basket that I put my measured meds in. This way I have it with me when I’m hooking him up to the feeding tube. I apply it once I’m done, twice daily. So long as I remember to do this, the skin around his button is never red anymore.
Don’t use the syringe that comes with the button to give meds. The tip is smaller, and after washing it a few times, it will break. Then you won’t have a syringe to get the water out of the button’s balloon. You’ll need to open a new button to get a new syringe.
BTW, if you ever have problems with getting the water out of that balloon, look at the space that the tip of the syringe goes in for sucking the water out of it. There’s probably gunk in there. Just use something small to get it out. I’ve had one button in all these years where the balloon just would not deflate for me. Probably defective. Rather than making a trip to the doctor just to change a button, I wound up using the end of the cap for a Bic pen (long part) and breaking the spring in there to get it to deflate.
U.S. Food and Drug Administration
Mayo Clinic’s article on Medical History: Compiling your medical family tree
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Hi,
All of that info is great. I work 5 days a week with J-tubes and find that the addto tip on syringes work very well. They work well on luer lock and slip tip syringes. They do not slip off and they work well with the size of a port that my girl has. We never use the med port as once it has been used it will not stay shut.
I am not sure it you have heard of a product called mepilex, it is a soft foam dressing that we put under her j-tube it pulls the moisture away from the skin. It is great stuff, it has worked very well at protecting the site from breakdown.
It is nice to read all of the info that you have posted. I was looking for some other info and just happened to run across this.
Thanks
Angela