Soins complexes à domicile pour enfants
https://complexcareathomeforchildren.com

Medication administration

Indications

NOTE: For ease of reading the rest of the text, the word (nutritional) “formula” also includes “breast milk”, “fortified breast milk” or “infant formula”.

Considerations:

Frequency

According to the medical prescription.

Required materials

If needed:

Refer to your healthcare team if the material used at home or the sequence of steps taught is different from what is described in the method of care. 

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the care method of care.

The steps of the methods of care are illustrated by a nasogastric tube.

The steps of the “By pump” method of care are illustrated by a Kangaroo Joey pump ™.

Nasal tube


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the material

  • Set up on a flat surface or a well-cleaned table.
  • Gather and inspect all equipment to ensure that it is not damaged.
  • Fill the syringe #1 with the amount of water recommended by your healthcare team.
Why ?

This step ensures that the required materials are on hand in order to start the procedure.

Step 5: Position your child

Place your child in a seated or semi-seated position according to your child’s comfort and capacity

Why ?

This position facilitates digestion and avoids aspiration of the medication into the lungs.

Step 6: Discontinue feeding session, if in progress

If the feeding session is not in progress, go to the next step. 

  • Turn off the pump.
  • Bend the nasal tube.
  • Disconnect the tubing from the tube.
  • Replace the cap at the end of the tube.
  • Release the tube.
  • Put a cap on the end of the tubing or place the end of the tubing on a clean compress.
  • Then proceed to step 8.
Why ?

Mixing medications and formula may cause problems such as:  changing the effect of the medication or causing blockages.  Temporarily stopping the formula feeding to give medications reduces these risks.

Step 7: Check the location of the nasal tube

  • Make a visual inspection of your child’s tube; check to see if it is intact.
  • Check to see if there are any changes in the outer portion of the tube, if the mark is still in the same place and if the adhesive bandage is securely in place.
  • Aspirate some gastric secretions, if recommended by your healthcare team: first inject air to empty the tube and then aspirate to get a sample directly from the stomach.
  • Afterwards, check the pH of this gastric fluid, if recommended by your healthcare team.
Why ?

This step ensures the safe use of the tube.

Step 8: Irrigate the nasal tube

  • Bend the tube and remove its cap.
  • Connect the syringe to the end of the tube.
  • Release the tube.
  • Slowly depress the plunger of the syringe to push the water into the tube.
  • When the syringe is empty, bend the tube.
  • Disconnect the syringe.
  • Replace the cap at the end of the tube.
  • Release the tube.
Why ?

This step clears the tube and prevents blockage and possible interactions between the formula remaining in the tube and the medication.

Step 9: Aspirate the medication into the medication syringe

  • Remove the protective cap from the feeding syringe #2.
  • Dip the end of the syringe into the container and draw up the medication by pulling the plunger.
  • Fill the syringe with the required amount of medication.
  • Hold the syringe with the pointed end upwards and remove the air from the syringe by gently depressing the plunger until a drop of medication comes out of the tip of the syringe.
Why ?

This step fills the syringe with the amount of medication to be given and removes the air from the syringe.

Step 10: Connect the syringe to the nasal tube

  • Bend the tube and remove its cap.
  • Connect the syringe to the end of the tube.
  • Release the tube.
Why ?

Connecting the syringe to the nasal tube allows the medication to be given by push.

Step 11: Administer the medication

  • Slowly depress the plunger of the syringe #2.
  • Continue until your child has received all the medication.
Why ?

This ensures that the medication reaches the stomach safely.

Step 12: Disconnect the syringe from the nasal tube

When all the medication is administered:

  • Bend the tube.
  • Disconnect the syringe #2 from the tube.
  • Replace the cap at the end of the tube.
  • Release the tube.
Why ?

This step clears the tube for irrigation.

Step 13: Irrigate the nasal tube

  • Bend the tube and remove its cap.
  • Connect the syringe #1 to the end of the tube.
  • Release the tube.
  • Slowly depress the plunger of the syringe to push the water into the tube.
  • When the syringe is empty, bend the tube.
  • Disconnect the syringe #1.
  • Replace the cap at the end of the tube.
  • Release the tube.
Why ?

This step ensures that all of the medication was given and reduces the risk of the tube being blocked with left over traces of medication.

Step 14: Resume the feeding session, if necessary

Taking into account the time required after the administration of the medication, as indicated by your healthcare team:

  • Reconnect the tubing to the nasal tube.
  • Start the pump.
Why ?

This step allows you to continue the temporarily stopped feeding session.

Step 15: Clean and store equipment

Clean, maintain and store equipment as recommended.

Why ?

This step is necessary to ensure cleanliness and proper functioning of the equipment for the next use.

Step 16: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.

Button


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the material

  • Set up on a flat surface or a well-cleaned table.
  • Gather and inspect all equipment to ensure that it is not damaged.
  • Fill the syringe #1 with the amount of water recommended by your healthcare team.
Why ?

This step ensures that the required materials are on hand in order to start the procedure.

Step 5: Position your child

Place your child in a seated or semi-seated position according to your child’s comfort and capacity.

Why ?

This position facilitates digestion and avoids aspiration of the medication into the lungs.

Step 6: Discontinue feeding session, if in progress

If the feeding session is not in progress, go to the next step. 

  • Turn off the pump.
  • Bend the nasal tube.
  • Disconnect the tubing from the tube.
  • Replace the cap at the end of the tube.
  • Release the tube.
  • Put a cap on the end of the tubing or place the end of the tubing on a clean compress.
  • Then proceed to step 10.
Why ?

Mixing medications and formula may cause problems such as: changing the effect of the medication or causing blockages.  Temporarily stopping the formula feeding to give medications reduces these risks.

Step 7: Check the location of the button

  • Make a visual inspection your child’s button; check to see if it is intact.
  • Check to see if the button is correctly in place and not pushed into the stoma, or too far out of the stoma.
Why ?

This step ensures the safe use of the button.

Step 8: Irrigate the button extension set

  • Remove the cover from the feeding port or medication port, depending on the type of extension set.
  • If the extension set has two ports, ensure that the feeding port remains closed throughout the procedure.
  • Connect the #1 syringe to the end of the extension set.
  • Make sure the extension set clamp is open.
  • Depress the plunger of the syringe to inject water all the way to the end of the extension set.
  • Close the clamp on the extension set.
  • Leave the syringe connected to the extension set.
Why ?

This step ensures that the extension set tubing is filled with water and ready to flush into the button feeding port.

Step 9: Connect the extension set to the button

  • Remove the cover from the button feeding port, if closed.
  • Make sure the port is clean.
  • Hold the sides of the button and insert the extension set into the feeding port.
  • Lock the extension set into the button, according to the manufacturer’s instructions or those of your healthcare team.
Why ?

This step prepares for verification of the button location and irrigation.

Holding the sides of the button helps to stabilize it during the installation of the extension set.

Step 10: Irrigate the button

  • Open the clamp of the extension set.
  • Slowly depress the plunger of the syringe #1 (already connected to the extension set) to push the water into the button.
  • When the syringe is empty, close the clamp of the extension set.
  • Disconnect the syringe #1.
  • Replace the cover on the feeding port of the extension set.
Why ?

This step clears the button and prevents blockage and possible interactions between the formula remaining in the button and the medication.

Step 11: Aspirate the medication into the syringe for the medication

  • Remove the protective cap from the feeding syringe #2.
  • Dip the end of the syringe into the container and draw up the medication by pulling the plunger.
  • Fill the syringe with the required amount of medication.
  • Hold the syringe with the pointed end upwards and remove the air from the syringe by gently depressing the plunger until a drop of medication comes out of the tip of the syringe.
Why ?

This step fills the syringe with the amount of medication to be given and removes the air from the syringe.

Step 12: Connect the syringe to the button extension set

  • Remove the cover from the appropriate port of the extension set.
  • Connect the #2 syringe into the extension port.
  • Open the extension set clamp.
Why ?

Connecting the syringe to the button extension set allows the medication to be given by push.

Step 13: Administer the medication

  • Slowly depress the plunger of the syringe #2.
  • Continue until your child has received all the medication.
Why ?

This ensures that the medication reaches the stomach safely.

Step 14: Disconnect the feeding syringe from the button extension set

When all the medication is administered:

  • Close the button extension set clamp.
  • Disconnect the syringe #2 from the extension set.
  • Replace the cover on the extension set
Why ?

This step clears the extension for irrigation.

Step 15: Irrigate the button

  • Remove the cover from the extension set.
  • Connect the syringe #1 to the end of the extension set.
  • Open the clamp of the extension set.
  • Slowly depress the plunger of the syringe #1 to push the water into the button.
  • When the syringe is empty, close the clamp of the extension set.
  • Disconnect the syringe #1.
  • Replace the cover on the feeding port of the extension set.
Why ?

This step ensures that all of the medication was given and reduces the risk of the button being blocked with left over traces of medication.

Step 16: Resume the feeding session, if necessary

Taking into account the time required after the administration of the medication, as indicated by your healthcare team:

  • Reconnect the tubing to the nasal tube.
  • Start the pump.
Why ?

This step allows you to continue the temporarily stopped feeding session.

Step 17: Disconnect the button extension set

  • Hold the sides of the button.
  • Unlock the button extension set, as directed by the manufacturer or your healthcare team.
  • Remove the extension set from the button feeding port.
  • Put the cover on the button feeding port.

Why ?

If the extension set is held in place, your child may accidentally pull on it and move the button, in addition to being cumbersome.

Holding the sides of the button helps stabilize the button while the extension set is being removed.

Closing the cover prevents leakage of the stomach contents through the button in between feeding sessions.

Step 18: Clean and store equipment

Clean, maintain and store equipment as recommended.

Why ?

This step is necessary to ensure cleanliness and proper functioning of the equipment for the next use.

Step 19: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.

Enterostomy long tube


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the material

  • Set up on a flat surface or a well-cleaned table.
  • Gather and inspect all equipment to ensure that it is not damaged.
  • Fill the syringe #1 with the amount of water recommended by your healthcare team.
Why ?

This step ensures that the required materials are on hand in order to start the procedure.

Step 5: Position your child

Place your child in a seated or semi-seated position according to your child’s comfort and capacity.

Why ?

This position facilitates digestion and avoids aspiration of the formula into the lungs.

Step 6: Discontinue feeding session, if in progress

If the feeding session is not in progress, go to the next step. 

  • Turn off the pump.
  • Bend the tube.
  • Disconnect the tubing from the long tube feeding port.
  • Replace the cover at the end of the feeding port.
  • Release the tube.
  • Put a cap on the end of the tubing or place the end of the tubing on a clean compress.
  • Then proceed to step 8.
Why ?

Mixing medications and formula may cause problems such as: changing the effect of the medication or causing blockages.  Temporarily stopping the formula feeding to give medications reduces these risks.

Step 7: Check the location of the long tube

  • Make a visual inspection of your child’s long tube; check to see if it is intact.
  • Check to see if there are any changes in the outer portion of the tube.
Why ?

This step ensures the safe use of the long tube.

Step 8: Irrigate the long tube

  • Bend the tube and remove its cover.
  • Connect the syringe #1 to the tube.
  • Release the tube.
  • Slowly depress the plunger of the syringe to push the water into the tube.
  • When the syringe is empty, bend the tube.
  • Disconnect the syringe #1.
  • Replace the cover on the tube.
  • Release the tube.
Why ?

This step clears the tube and prevents blockage and possible interactions between the formula remaining in the long tube and the medication.

Step 9: Aspirate the medication into the medication syringe

  • Remove the protective cap from the feeding syringe #2.
  • Dip the end of the syringe into the container and draw up the medication by pulling the plunger.
  • Fill the syringe with the required amount of medication.
  • Hold the syringe with the pointed end upwards and remove the air from the syringe by gently depressing the plunger until a drop of medication comes out of the tip of the syringe.
Why ?

This step fills the syringe with the amount of medication to be given and removes the air from the syringe.

Step 10: Connect the feeding syringe to the long tube

  • Bend the tube and remove its cover.
  • Connect the syringe #2 to the tube.
  • Release the tube.
Why ?

Connecting the syringe to the long tube allows the medication to be given by push.

Step 11: Administer the medication

  • Slowly press the plunger of the syringe #2.
  • Continue until your child has received all the medication.
Why ?

This ensures that the medication reaches the stomach safely.

Step 12: Disconnect the syringe from the long tube

When all the medication is administered:

  • Bend the tube.
  • Disconnect the syringe #2 from the tube.
  • Replace the cover on the tube.
  • Release the tube.
Why ?

This step clears the long tube for irrigation.

Step 13: Irrigate the long tube

  • Bend the tube and remove its cover.
  • Connect the syringe #1 to the tube.
  • Release the tube.
  • Slowly depress the plunger of the syringe to push the water into the tube.
  • When the syringe is empty, bend the tube.
  • Disconnect the syringe #1.
  • Replace the cover on the tube.
  • Release the tube.
Why ?

This step ensures that all of the medication was given and reduces the risk of the long tube being blocked with left over traces of medication.

Step 14: Resume the feeding session, if necessary

Taking into account the time required after the administration of the medication, as indicated by your healthcare team:

  • Reconnect the tubing to the long tube feeding port.
  • Start the pump.
Why ?

This step allows you to continue the temporarily stopped feeding session.

Step 15: Clean and store equipment

Clean, maintain and store equipment as recommended.

Why ?

This step is necessary to ensure cleanliness and proper functioning of the equipment for the next use.

Step 16: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : NRoss .Version : 1.0

https://complexcareathomeforchildren.com/enteral-nutrition/medication-administration/

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A collaboration of clinical experts across Quebec has taken every care to ensure that the information contained in this document is accurate, complete, and reflective of evidence-based practices. However, “Complex care at home for children” collaboration cannot and does not assume any responsibility for application of the content of this document or for any information that may be present in the websites cited as a reference. These web sites are provided for informational purposes only and do not represent the collaboration endorsement of any companies or products. Always consult your child’s physician and/or a qualified healthcare professional to learn more about recommendations specific to your child’s health needs.

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