Clinical Inquiry - first of a series

The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice.  Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care.  Here is the first of our series entitled "Clinical Inquiry".

Q: Why do we use sterile water to flush NG tubes? Why can't we use bottled or tap water?
A: Bottled or tap water is only indicated for hydration in healthy patients who are not immunocompromised.  Acutely ill patients or those with chronic conditions that have any alterations to the GI tract are vulnerable to nosocomial infections from non-sterile products including water.  This also holds true for patients who are immunocompromised but not acutely ill.  Because tap water contains metals, medications should only be diluted in sterile water to prevent reduction of bioavailability.  Tap water also has the potential to be a source of contamination when reconstituting formula.  Filtration of water may be beneficial but still poses a risk for contamination.  Sterile water is solute-free and free of chemical or microbial contaminants; therefore, it is the only type of water that should be used to flush NG tubes, dilute medications and reconstitute formula.

response written by Kathleen Pentecost, SRN CBU, BA Sociology & Carla I. Morales, SRN CBU, BS Psychobiology

Bankhead, R., Boullata, B.S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., et al. (2009) A.S.P.E.N. Enteral nutrition    practice recommendations. Journal of Enteral and Parenteral Nutrition, 33, 122-69.