Tips and Tricks: How To Crush and Prepare Medications

Taking medications on a G-tube can be overwhelming and feel like it a huge constant time suck. To help with this, my husband and I decided to follow a routine where we crush/prepare med cups at most every 4 days and fill med syringes every other day.

I cannot recommend enough getting a high quality crusher, like a Silent Knight.

These tricks and tips will hopefully free you up from feeling like you’re always preparing medications, save your wrists, and save you some headaches.

Pre-crushing and Filling Syringes

Steps

Step 1 : Prepare Cups

2oz “jello shooter” cups work great for mixing powdered medications, storing crushed prepared meds, and they can be cleaned and reused.

Tip: If traveling, label an associated sleeve for each cup of pre-crushed medication you will be bringing with you.

Label one cup lid for each med dose.
Label the lid with an abbreviation for the medication(s) crushed inside.
- Zofran”, “R+M”, “Night Meds”, etc.
You can combine multiple meds in one cup/syringe as long as the powder volume isn’t too large.
Bottoms are interchangable, no need to label.

Step 2 : Crushing Tablets and Adding Capsules

My nurses have told me improperly crushed medications or trying to do too much powder in one syringe are the most common causes of tube clogs.

Organizing your cups and sorting your pills before you get started crushing is essential to not getting lost and missing or doubling doses.

Verify medications are NOT time released. Time release medications should not be crushed and administered via G/GJ/J tube unless EXPLICITLY stated to do so by the pharmacist and your doctor. Always double check! Crushing will cause you to get the entire time released dose at one time instead of spread out over the extended time as intended.

Place one cup per dose (syringe), in groups by med type.
Place all pills and capsules for one syringe in one cup. Verify all medications are correct in all cups prior to proceeding.
Place the associated lids label down and any associated capsules on them.
Using your preferred crusher, make sure tablets are finely ground into a powder.
- Pill coatings are the hardest to breakdown. Crush thoroughly.
If reusing sleeves, keep them separated by med type/group
Open capsules into the associated cup and put a lid on it right away.
- It is too easy to forget which ones you have added the capsules to if you don’t cap it!

A good pill crusher saves time and does a good job of getting the powder extremely fine and saves your wrists!

Step 3 : Pre-filling Crushed Medication Syringes

During crushing, pulling into the syringe, and administering some residue will be left behind. Many people require slightly higher prescription dose of medication on tube feeds because of this loss.

Syringe Volumes Used

	20ml	60ml
Soak H₂O	10ml	15ml
Rinse H₂O	5ml	15ml
Pills	1 Lg 2-3 S	2 Lg 3-5 S

The proper syringes and soaking makes med prep more successful. We generally use 20ml and 60ml offset tip syringes for crushed medications dissolved in water.

Add initial water* to the cup of powdered meds, cap it, let it soak for 15+ minutes.
After sitting, mix the medications and water with the tip of the syringe.
Suck up as much of the solids from the bottom, remembering to run the tip of the syringe along the bottom cup corner.
Place the syringe tip up, pull the plunger back to clear the tip, tap, and push air out.
Rinse* the tip of the syringe and the sides and bottom of the cup to get the remaining residue off.
Suck up as much of the residue rinse as you can.
Place the syringe tip up, pull the plunger back to clear the tip, tap, push air out, and place a cap on.
Place into a labeled slot or ziplock bag with medication identifier.

Step 4: Pre-filling Liquid Medication Syringes

Make a Med/Food Straw

Cut the tube attachment off an extension but leave the syringe attachment and enough tube length to reach the bottom of the med bottle.

Some liquids are easiest to draw up using a “med/food straw” while others work best with a bottle to ENfit adaptor.

Using a med/food straw for larger volumes:

Attach a syringe to the end of the med/food straw.
Place the tip of the straw into the medication and pull the medication into the syringe. Clamp the extension and remove the syringe. Tap and remove air.
Reattach a syringe and fill up to the appropriate line. Repeat for all syringes.
Detach the last syringe, release the clamp, and let the remaining medication in the tube drain back into the bottle.
Place tip of syringe in water and pull back to dilute if desired.
Place the syringe tip up, pull the plunger back to clear the tip, tap, push air out, and place a cap on.
Place into a labeled slot or ziplock bag with medication identifier.

Using ENfit bottle adapter for small volumes:

Place ENfit adapter into medication bottle opening.
Screw ENfit syringe onto bottle (adapter).
Turn bottle upside down, syringe tip up, and draw medication to the correct dose.
Cap syringe and bottle.
Place into a labeled slot or ziplock bag with medication identifier.

Step 5: Wrapping Up

After you have finished filling your syringes wash the used cup bottoms and med/food straw with hot soapy water.

Tip: I find the cup bottoms dry best if you give them a couple hard shakes after rinsing.

Store your backstock of crushed medicine cups and pre-filled syringes where they won’t get knocked over, Refill syringes on a schedule that works for you.

Relax! You earned it!