Forum Posts

Bruce Collett
Sep 20, 2022
In ENFit
Is the RxCrush system strictly for Ng/Gtube patients?, or do you have a different packaging for meds that need to be crushed for oral consumption? Yes, RxCrush does a very effective job crushing medications for oral consumption, like adding to applesauce, or pudding, or syrup, and the pouches to use for that purpose are PP10, and PP20. Both provide protection and retain dose while crushing; no dust escapes during crushing while using the pouches. Both are easy to use because they have tear off tops so the pouch content can be poured without a lot of mess.
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Bruce Collett
Sep 09, 2022
In Hazardous Drug Prep - USP<800>
Question received by Heather Demyan, Nurse Educator at The Ohio State U Medical Center. Is this device approved for hazardous medication administration? Yes, RxCrush was designed to increase safety while manipulating hazardous medications. The pouches create a "contained" system that keeps medication dust and liquid under control through the process. Proper and prudent precautions need to be used ie, PPE, controlled negative atmosphere room or hood etc. Also the instruction steps listed in the "How to Use" section of the web site need to be followed carefully to keep liquid contained in the pouch and the syringe while transferring dissolved medications to feeding systems. https://www.rxcrush.com/how-it-works USP<800> refers to a pouch that contains hazardous medication while crushing. See the letter explaining our position here: https://www.rxcrush.com/_files/ugd/d847c7_1d005a2193cb41ecac8b7b19782261e4.pdf
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Bruce Collett
Aug 18, 2022
In How to Use
This question has many different factors to consider which should be determined by pharmacists at each hospital. There are guidelines about compounding various levels of hazardous drugs contained in USP Chapters <800> and <795>. Our RxCrush customers follow their own policies which often depends on the equipment and layout of pharmacists in hospitals. Drugs without a NIOSH Hazardous Drug classification can be compounded with RxCrush on the hospital floor and RxCrush contains this process better than any other process because the RxCrush Pill Pouch contains the solid medications and fluids during preparation. NIOSH Level 1, 2 and 3 drugs require more care. There is a list compiled by NIOSH for the 3 levels of hazardous drugs. The list can be found here: https://www.cdc.gov/niosh/docs/2010-167/pdfs/2010-167.pdf It is the drugs on this list that should be approved by pharmacists. USP<800> and <795> mandates as much protection should be adopted in work areas as possible given the resources of the hospital. RxCrush makes the containers and the crusher for pill crushing but don't have the scope to determine crushing protocol.
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Bruce Collett
Aug 17, 2022
In ENFit
In March of 2022 GEDSA published definitive information about converting to ENFit. If you haven't seen it yet take a look here: https://stayconnected.org/wp-content/uploads/2022/03/GEDSA-Unified-ENFit-Conversion-Message-Book-20220315.pdf
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Bruce Collett
Aug 17, 2022
In ENFit
Follow the links in the stayconnected.org website for ENFit information and reports on progress toward the adoption of ENFit for enteral feeding throughout the world. https://www.businesswire.com/news/home/20220315006117/en/Enteral-Device-Product-Discontinuation-Update
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Bruce Collett
Jun 16, 2022
In How to Use
If you use the PP06 Pill Pouch to crush the meds, attach the syringe with water before crushing. Eject water into the pouch to dissolve the crushed medication, then extract the dissolved solution with the syringe and empty the syringe into food. The best solution is to use RxCrush's Pediatric, Sealed, Tear Off Pill Pouch, item PP10 as shown on the store page: https://www.rxcrush.com/product-page/pp10-rxcrush-pediatric-sealed-tear-off-pill-pouch-qty50. Use RxCrush Pill Crusher to crush medications that are placed in the pouch and sealed. The pouch has enough length to use under the crusher without endangering fingers and no syringe is needed to work the pouch under the crusher. After crushing, tear off the top of the pouch and pour into applesauce, or pudding or other edible foods.
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Bruce Collett
Jun 07, 2022
In How to Use
The amount of liquid varies depending on the patient. Some little people are unable to take in more than 15ml of liquid whereas adults have much larger capacity. The PP06 RxCrush Pill Pouch has a total volume capacity of 50ml. For most adult patients 20 - 22ml is the optimum amount to use and is delivered by syringes of that range. In the RxCrush catalog see https://www.rxcrush.com/product-page/syen20-20-ml-female-enfit-syringe-qty-50 Pediatric patient dosages can be managed with the use of 1ml to 5ml syringes. For those who can handle less liquid the PP08 RxCrush Pediatric Pill Pouch helps crush and dissolve and deliver medication with less liquid.
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Bruce Collett
Jun 07, 2022
In ENFit
There isn't currently a .5ml or 1/2 ml ENFit syringe available. For the time being we recommend using a 1ml ENFit LDT syringe, item SYEN1-LDT, and carefully draw dissolved medication material into 1/2 of the 1ml syringe. The PP08 RxCrush Pediatric Pill Pouch is small enough to crush and dissolve small pills using a 1ml or larger ENFit syringe.
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Bruce Collett
May 16, 2022
In Hazardous Drug Prep - USP<800>
The amount of PPE depends on level of HD. Take a look at the video from Elkhart Hospital that is posted as a YouTube and can be found on our How To page. The practices demonstrated in the video are suggestions and not certified by Elkhart or US Pharmacopeia (USP). For the most widely recognized guidance, take a look at USP.org. USP holds seminars about UPS<800> and other chapters like USP<795> and USP<797> including presentations by pharmacists and healthcare workplace safety experts. Look for There are other discussions about USP<800> in our Forum.
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Bruce Collett
Apr 21, 2022
In How to Use
The RxCrush Pill Pouch is meant to be a one time use. Also pharmacists recommend that only one drug be crushed at a time.
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Bruce Collett
Mar 09, 2022
In How to Use
"Crushing a med in the pharmacy but not mixing it there, does the pouch need a cap? Will any crushed powder escape if there is no cap?", is the question asked by a customer. A cap isn't absolutely necessary but recommended. The pill pouch is likely to have some pill dust escape while the meds are crushed in the pouch and when the pouch is handled or transported unless the pouch is capped or sealed with an ENFit syringe. We recommend using our item number CA03 to seal the pouch while crushing and handling, which is shown here:https://www.rxcrush.com/product-page/ca03-enfit-pill-pouch-cap-qty-100-1. A syringe attached to the pouch acts as a handle for the pouch while meds are being crushed in the RxCrush Pill Crusher. The CA03 cap also is a useful handle for the pouch while crushing and transporting.
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Bruce Collett
Feb 28, 2022
In Device Maintenance
A long time customer wants to know how to eliminate noise from crushers that squeak from the roller. The roller is made of PVC material and is mounted on a stainless steel shaft. Many cycles of crushing and cleaning of the crusher may dry out the materials enough to cause squeaking. The remedy is to use a Q Tip to apply petroleum jelly on the stainless steel shaft at the place where the snap ring holds the roller in place. Dab a small amount of petroleum jelly and then roll back in forth, working the jelly into the gap between the roller and the shaft. After several cycles the jelly will cover the space and will eliminate any squeaks.
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Bruce Collett
Feb 18, 2022
In How to Use
There are various opinions about crushing more than one medication at a time. Different pharmacists require only 1 medication to be crushed at a time. Other pharmacists approve crushing a collection of meds at a time. There doesn't seem to be standard guidance from the pharmacy world. The PP06 pouch can hold 50ml of liquid. We have tested 8 pills in one crushing and with enough crushing and rolling to pulverize medications into fine dust, it has been effective handling 8 different medications.
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Bruce Collett
Feb 03, 2022
In Hazardous Drug Prep - USP<800>
Fred Massoomi, PharmD, BCSCP, FASHP, is senior director of hospital and health-system pharmacy for Visante, Inc. He received his doctorate from the University of Kansas School of Pharmacy. Fred is a member of PP&P’s Editorial Board. See the link to this article in
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Bruce Collett
Apr 09, 2021
In How to Use
A nurse was asking me if they could use thickener either with the water in the pouch or after drawing it up in the syringe if the crushed medication was to be given orally in a patient on a honey thick diet. They use a thickening powder I believe for these patients. Would they be able to crush, dissolve in the water, draw out, and then add the thickener in a separate container before administering orally? Thanks, -- Christy Havens, PharmD, BCPS Supervisor Inpatient Pharmacy CHI Health Creighton University Medical Center-Bergan Mercy CHI Health Lasting Hope Recovery Center CHI Health University Campus 402.398.5971 (O) christine.havens@commonspirit.org
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Bruce Collett
Feb 01, 2021
In How to Use
Capsules that contain granulated medication can be crushed in Rx Crush Pill Pouches with some additional technique. After putting a capsule in the Rx Crush Pill Pouch with a syringe attached with liquid in the syringe, use the crush plate of the Rx Crush Pill Crusher to crack open the capsule. Press the crusher only once to crack the capsule to minimize the number of fragments of the capsule in the pouch. Shake the pill pouch to empty granules from the capsule. Use fingers to manipulate the capsule to remove granules. Inject liquid in the syringe to transfer the granulated medication into an enteral feeding tube. Shake the pill pouch with the liquid to concentrate granules at the bottom of the pill pouch. Its helpful to trap the capsule with fingers to keep the capsule material in the upper part of the pill pouch. Capsule material will clog the opening of the Rx Crush Pill Pouch so isolate the capsule by holding it in another part of the pouch. The granulated medication will easily be sucked into the syringe so it can then be injected into an enteral feeding tube. There needs to be more than one irrigation process to clear all the granules from the Rx Crush Pill Pouch to the syringe and into enteral feeding gear. Pictures of the process are shown below.
Crushing Capsules with Granules content media
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Bruce Collett
Jan 21, 2021
In Covid-19
The USP web site has updates about the status of vaccines and the latest care advice. It can be found here: https://www.usp.org/covid-19
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Bruce Collett
Jan 21, 2021
In How to Use
Review the steps for using Rx Crush and how to attach syringes to pill pouch. Here is a video showing regular steps which need to be adapted to use with Gel caps. https://www.rxcrush.com/how-it-works. Before putting gel cap into an Rx Crush Pill pouch, lance the gel cap with a needle and drop into an Rx Crush pill pouch. After the pouch is sealed and a syringe is attached with diluent loaded into the syringe, use the Crush plate of the crusher to squeeze the contents of the gel capsule into the pouch. There is no need to use the roller of the Crusher although it may be useful to empty the gel cap. Inject solution into the Rx Crush pill pouch and shake vigorously to dissolve the medication. The process may need to be repeated several times to dissolve all the medication. Gel caps can be dissolved without emptying the gel cap using warm water but it does take a while to dissolve the gel cap.
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Bruce Collett
Jan 21, 2021
In How to Use
Rx Crush Pill Pouches and Pill Crusher can be used to crush hard capsules and dissolve medication for introduction into enteral feeding systems and or into food. Review the How to Use video here to become familiar with the steps for using Rx Crush. https://www.rxcrush.com/how-it-works. Here are some steps to accomplish this. Use the crush plate on the pill crusher to crack open the hard capsule shell of the medication. Crush the capsule as little as possible to reduce the number of capsule fragments. Avoid using the roller on the capsule for the same reason. Tap and shake the pouch to remove as much medication from the capsule as possible. Inject liquid into the pill pouch using the attached syringe. There will still be some medication in the capsule that will dissolve after diluent is introduced into the pouch. Shake the solution and medication vigorously to dissolve as much of the medication as possible. Use fingers to trap capsule material while extracting solution from the pill pouch. Capsule fragments can plug the opening to the pouch fitting so keep those fragments away from the opening while drawing out the syringe. Repeat as many times as necessary to dissolve all the medication.
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Bruce Collett
May 11, 2020
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