Favorite Tricks for Medications by G-Tube

We love, love, love our daughter’s g-tube for more reasons than I can list here, so for now I’ll just share why we love it for medications. Gone are the days of forcing bitter liquids down her throat or trying to get her uncoordinated little muscles to try to swallow a pill. We know she is getting her correct full dose every time, even if she is sound asleep.
That is not to say that there aren’t some little tricks to simplify taking medications by g-tube. The following are some strategies we stumbled across after trial and error—things I wish we’d known from the beginning.

I try to get all her medications in tablet or capsule form rather than in sticky, sugary liquid versions. These syrups squirt on the ceiling and coat the tube ports so that they have a nasty habit of popping open…especially in the middle of the night. We just don’t have these problems with tablets or capsules, so they’re what I stick with. The doctors tend to look at me funny when I request her prescriptions in tablet form, but I’d much prefer to crush than to deal with stickiness. And another thing--I'm admittedly cheap frugal. Since the bill for compounding is high and often not covered by insurance, I'm happy to spend a few seconds of elbow grease to save hundreds of dollars on compounding each year.
If you are using tablets, a weekly pill minder is fabulous. It helps you keep from making dosing errors, especially if your child takes more than one medication. Trust me. They’re cheap (even free at some pharmacies).
Some tablets dissolve beautifully in water. Try a spare one. Just keep in mind that any medication should be given as soon as dissolved—ideally in less than half a hour—because some medications begin to degrade when wet.
Other tablets need to be crushed. We love our mortar and pestle, a Coors brand set made for pharmacists. The 250cc-sized pair runs about $50 online, which may seem steep but has been worth every penny to us. Sometimes you can find adequate substitutes at a gourmet cooking shop, but they must be SMOOTH inside (grooves will hold that accurately measured powder, and many of the marble sets are badly grooved). Also make sure you get one large enough to crush the maximum number of pills your child will need. Our daughter has taken up to 15+ tablets in a single dose, combining all the drugs and vitamin/mineral supplements she was prescribed. A 250cc mortar is about the size of half a grapefruit and can crush a handy little pile of pills in one go. Smaller ones make work for your wrist. Remember, your wrists are in this business of caregiving for the long haul. Take good care of them. Oh, one more great thing about a quality mortar and pestle set…it can go through the dishwasher.
A small silicone spatula is WONDERFUL for scraping out every last bit of medication dust so you know you are offering a full dose.
I save those little medication cups from the hospital to transfer the powder to a syringe. You know the ones—they are clear and slightly flexible and hold 1 oz (30cc). After you have transferred the powder to them, they squish into a very precise little pouring cup. We’ve used some of ours for 10+ years. [Note, the rigid plastic cups that come with your cold syrup are awful. You want pliable ones]
Speaking of syringes, my favorite for medications are the 35cc slip-tip type. These have nice wide openings to pour in the powder. They also draw up plenty of water to dissolve it. Between the water to dissolve the medication and a 30cc rinse, your child can get a handy 2oz “drink” with every med dose.
Now, sometimes that little slip-tip can clog. I’d rather have clogs in the syringe than the g-tube! But there are things you can do to prevent clogs.
  • Of course, grinding the pills down to a fine powder is one.
  • Another is to allow the powder to sit for 5 minutes in the syringe after you have sucked up the water.
  • Sometimes the water needs to be thickened to prevent clogs. [Why? Well, here is my reasoning—all speculation, but the solution works dandy. Think back to your geology or minerology class…some rocks break apart with a distinct cleavage (“the tendency to split of a crystallized substance along definite crystalline planes, yielding smooth surfaces”). These particles, with their flat surfaces, nestle back together to make solid little dams. Now, medications appear to sometimes act in this same way, forming clogs from perfectly fine powder. My guess is that their particles have cleaved in such a way as to form a dense mass that acts to clog the syringe tip. But! if you can keep the particles in suspension they cannot form a mass]. Thickening the water keeps the particles suspended. My favorite for this is instant baby cereal. I like it because it is dry, and you are mixing dry into your dry medication powder. No messes! Some folks use applesauce or yogurt, which we have tried in the past, but I found them sticky, messy, difficult to transfer into the syringe…anhhhh, just stick with dry and you’ll be happy.
Flush, flush, flush the tubing when you are done. Not only does this give extra water, but it keeps the medications from sitting in the inner workings of the g-tube and doing destructive little activities there.
We do give our daughter several oil supplements (Vit. E, fish oil, flax oil) in gel caps. These do not do well in a mortar and pestle! Instead, I toss these into her food when I make up her homeblended meals. They act as a wonderful cue to know when all the food particles are thoroughly pulverized; this is the point at which the gel caps dissolve completely.
Please do add any tips or tricks you have for giving medications by g-tube. Together, we can shorten up the learning curve for other families. Thanks!

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Another post you might like:
G-Tube Jammies Tutorial


Aadhaar said...

OK, I'm not a huge mortar-and-pestle fan, especially since I found my little $5- plastic screw-action pill crusher. It's a bit like a small jar with a tamping bit attached to the lid; you just pop in the pill, screw it down, back and forth a few times, and you're done. Takes small pills, bit pills, anything NOT enteric coated. The enteric coated pills (like Nexium, for example) need to be dissolved. Many capsules have inside them tiny pillules with a smooth coating, and these have to be crushed also, or they will clog the works up. so here's my ritual:

I have a half-cup measuring cup, which I fill halfway with water, and pop in anything to be dissolved. While this is happening, I crush my crushables and add them to the water as I go. Then I'll add my liquid medicines like my herbal tinctures etc and Lactulose syrup if I'm having any. The dissovling has happened by now and so I use the tip of my big 60ml syringe to give it a good stir around, plug the syringe into my tube, and pour the medicine soup straight down. Then I'll follow that with another 50ml of water or so. My meds are always before feeding times, so that comes next, poured into the same syringe.

My doc and pharmacist have busted the old myth about having meds separately, as they both logically point out that they are all in your stomach at the same time. The only clog I've ever had came from not crushing well enough, and that was simply fixed by tipping the syringe contents back into the little measuring cup, tapping the syringe tip out (which is where the clog was), stirring, and tipping it all back in - no problemo.

Rose-Marie said...

Thanks so much for your input, Aadhaar!

We began with the blue twisty crushers as you describe and wore out so many of them that it was actually cheaper to just go the mortar and pestle route. But I did love how portable they were, especially with the little storage compartment in the lid.

I really like your suggestion of using half a cup of water (with the large rinse to bring it to nearly 3/4 c.!). It's nice to be able to sneak in extra water, so this is a great idea.

Thanks for the confirmation that it's okay to mix meds...

I appreciate you sharing your expertise! Thank you!

lomsuzie said...

Have you found any local stores that sell a large supply, like 100 count, of disposable med cups? I know they can be reused but my dad, who has a feeding tube, prefers to only use them for about 1 week. I have not been able to find med cups at any local pharmacies or Walmart or anywhere. Just online.

Rose-Marie said...

Lomsuzie, we have found them at Amazon.com and they work well (squishy sides). The "writing" is really embossing on the inside, but it isn't deep enough to cause an issue with medicine powder. The only ones I have found at local pharmacies are small packs of rigid ones, more like the ones that are included with a Nyquil bottle.

Hope that helps!

Grace Petron said...

What was in the blender with the oil capsules when they ground up successfully? I put one in with a can of Jevity and it was never where the blades hit it. I boiled a little water and dissolved it with a teaspoonful but don't know if heat is good for the fish oil. Do you have to have dense stuff to blend with a capsule?