why does liquid med through NG make the pt gag?

I was administering med through NG Fr 10. The NG was patent and in the right place; I got 15cc residual, heard air woosh through sthethoscope, the catheter length checked out. The HOB was at least 30 deg.

The pt was fine when I flushed/pushed 50cc water. But she gagged when I let liquid Ranitidine 10cc drain down from the open syringe. The pt thought the medication reflux is causing her to gag. I asked myself, "If so, why didn't she gag when I pushed 50cc of water a minute ago?" After the med, I again flush with 50cc of water by pushing it. The pt is fine. I let the tube feeding run at 80cc/hr. The pt is fine all night. I had the pt for two nights and same thing happened every time.

First of all, why would anything draining down the NG cause one to gag?

Can somebody explain this to me? Thanks
I know they can sometimes feel the tube move when you push fluid quickly but that is strange that she didn't do the same with the water.

You shouldn't be pushing anything through a NG, you allow it to flow by gravity. The stomach has chemical receptors and can cause a gag reflex when they are irritated.

Maybe I was using the wrong term for this, in our hospital the term NG and feeding tubes are used interchangeably even though they are two different things. With our feeding tubes we do push water and meds, tube feedings are ran by pumps, hope that makes sense.

Quote from FORTHELOVEOF!!!!Maybe I was using the wrong term for this, in our hospital the term NG and feeding tubes are used interchangeably even though they are two different things. With our feeding tubes we do push water and meds, tube feedings are ran by pumps, hope that makes sense.

A feeding tube is irritating to the gastrointestinal tract. Large or sudden volumes of medication or water can irritate even more causing a gag reflex or reflux. Medications, obviously, are more irritating than water so pushing medications is even worse. When you eat you do not "push" food down your throat and into your stomach, you allow it drop by gravity.

I agree you shouldn't be "pushing" anything through an NGT. Gentle guidance on the plunger should be enough. (unless of course are "pumping" an OD stomach but that is another situation all together)That being said........some patients have a huge gag reflex and the manipulation of the tube when nstilling the meds can stimulate the gag reflex...for some it is psychological at watching something "going in that tube".

You never push medications or fluids through any type of feeding tube. You administer by allowing the liquid to flow by gravity. A feeding tube is not an IV.

Another question if you don't mind. If we use a pump to adminster tube feedings and it's set on say 37ml/hr, this isn't using gravity is it? Is this ok because it is flowing slower than if I were pushing a flush or med?

Quote from FORTHELOVEOF!!!!Another question if you don't mind. If we use a pump to adminster tube feedings and it's set on say 37ml/hr, this isn't using gravity is it? Is this ok because it is flowing slower than if I were pushing a flush or med?

The largest amount I have pushed through an NG is 8 mls, 4ml for flush and 4 mls of medication, but these are babies so that's a decent amount. The exact directions I received while pushing was it doesn't matter how fast because if he were to take a drink it would all go down all at once, so it didn't matter. I'm not justifying it if it is wrong, just letting you know where the rationale is coming from. But again, thank you for the information and I will ask my instructor about it.

Quote from fortheloveof!!!!the largest amount i have pushed through an ng is 8 mls, 4ml for flush and 4 mls of medication, but these are babies so that's a decent amount. the exact directions i received while pushing was it doesn't matter how fast because if he were to take a drink it would all go down all at once, so it didn't matter. i'm not justifying it if it is wrong, just letting you know where the rationale is coming from. but again, thank you for the information and i will ask my instructor about it.

Yea I did kind of hijack their thread, sorry about that OP.