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.

St. Joseph Hospital Staff Publishes Article

Congratulations to the following St. Joseph Hospital staff for their newly published article on blood culture accuracy: Beth Winokur, RN, PhD, CEN, Debra Pai, RN, BSN, CEN, Dana Rutledge, RN, PhD, Kate Vogel, MA, CLS, MT, Sadeeka Al-Majid, RN, PhD, Christine Marshall, RN, MSN, CEN, CPEN and Paul Sheikewitz, MD!  SJO employees have access to the full article through Burlew Medical Library.  Contact library staff for more details.

J Emerg Nurs. 2014 Jul;40(4):323-9. doi: 10.1016/j.jen.2013.04.007. Epub 2013 Jun 29.

Blood culture accuracy: discards from central venous catheters in pediatric oncology patients in the emergency department.

Winokur EJ1, Pai D2, Rutledge DN2, Vogel K2, Al-Majid S2, Marshall C2, Sheikewitz P2.

Abstract

INTRODUCTION:

Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn.

METHODS:

During 2009-2011, 62 pediatric oncology patients with CVCs and orders for blood cultures to determine potential sepsis were enrolled during ED visits. Trained study nurses aseptically drew blood and injected the normally discarded first 5 mL and the second specimen (usual care) into separate culture bottles. Specimens were processed in the microbiology laboratory per hospital policy.

RESULTS:

Positive cultures were evaluated to assess agreement between specimen results and to determine that the identified pathogen was not a contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive results. In all positive-positive matches, the normal discard specimen contained the same organism as the usual care specimen. In 4 matches, the normally discarded specimen demonstrated notably earlier time to positivity (4 to 31 hours) compared with the usual care specimen, which resulted in earlier initiation of definitive antibiotics.

DISCUSSION:

These findings support the accuracy of the specimen that is normally discarded and suggest the need to reconsider its use for blood culture testing.