When my daughter first had her tube placed more than eight years ago, I was told very explicitly that all tablet or powder meds would need to be crushed in order to go through her tube. Actually, I was encouraged not to use tablet or powder meds at all, and to stick to non-sugary suspensions.
I’m one of those people who just isn’t good at crushing. No matter what system I used—pill crusher, back of a spoon, mortar and pestle—my daughter’s meds never seemed fully crushed. Not only that, but I felt like I was losing 10% of the med to the crushing container, adhered to the walls. And my poorly crushed meds had a bad tendency to clog up the extension set.
So I got lazy and stopped crushing. I decided to dissolve my daughter’s meds instead. It turned out that dissolving worked even better than crushing, with less loss of meds and no clogging.
The Dissolving Method
The Dissolving Method is simple. Take all of your tablets and powders, put them into one dry large syringe (10-60ml), and put the plunger in. Using a medicine cup or any other type of cup, suck up a minimum of 5ml water into the syringe (you may need more if you have a lot of meds). Leave a little air in the syringe so you swirl and shake the meds around. Swirl and shake. Make sure none of the meds are adhered to the top of the syringe, but are all sitting inside the water.
Then wait 30 minutes. This is very important. While some meds dissolve faster, others take as long as 30 minutes. Once you become more familiar with your child’s particular meds, you may be able to cut this time down to 5-10 minutes.
Once dissolved, swirl and shake again. Administer slowly through the feeding tube. If there is any residue left in the syringe, suck up another 1-3ml of water, swirl it around, and then administer that slowly through the feeding tube.
The main advantage of this system is that the actual preparation of the meds is much easier, though it does take some foresight. No more crushing, no more transferring, no more lost powder stuck to the side of the pill crusher.
I find that the vast majority of meds dissolve very well in water either completely or into a very fine powder. If given enough time, most meds will dissolve just fine.
Using this system, we have avoided any clogs of the feeding tube for the past almost 6 years. I find that the resulting suspension is much more uniform, and any residual powder is finer, preventing clogs.
We have also been able to administer large numbers of medications in a very small amount of liquid, which can be extremely helpful for children who are fluid restricted or experience pain with medication administration.
Also, if you have several dry syringes, you can make up many dosages of medications ahead of time. Simply put the tablets and powders into the syringe without adding water and store them in a cool, dry place. Shield the syringes from light, if necessary, and simply add the water a half an hour before you need to administer a dose.
Disadvantages and Caveats
The major disadvantage to this system is that you have to remember to prepare it—or add water to already prepared syringes—up to 30 minutes before the meds are due. This can be difficult for some parents or nurses. On the other hand, if you do forget, you can always choose to crush your meds that time. Sometimes when I am running behind, I halve or quarter my daughter’s tablets before adding them to the syringe so they dissolve faster.
There are certain medications that just don’t work with this system at all. Any meds that won’t dissolve in water are obviously out. Any meds that are in time-release, enteric-coated, or bead form should not be dissolved in this manner. Whole gelatin capsules should also not be dissolved (though you may be able to dissolve the contents of the capsule). We have experienced that a few meds tend to clump back together after dissolving, which could potentially lead to more clogs. The clumping meds tend to be from coated capsules.
Some medications should not be mixed together. Consult your pharmacist to find out which medications can be mixed together. Even if you can’t mix meds, you can still use this system by simply putting each medication in a separate syringe.
You should also check with your pharmacist to make sure it is OK to allow all of your child’s medications to sit in water for 30 minutes. In most cases this will be fine, but a few meds tend to lose potency if they sit too long. Also, some meds should be mixed with solutions of a certain pH, such as an acid like apple juice. Ask your pharmacist what solution is best for dissolving.
For information on specific medications and how to give them enterally, see “A Guide to Drug Therapy in Patients with Enteral Feeding Tubes.”
Saving Time and Energy
If your child’s medical needs are as substantial as my daughter’s, you know very well how important it is to save your time and energy. Hopefully this system will make it a little easier to give tablet form or powdered meds down a feeding tube.