STERILE WATER!!!!!

[mina123]

Does anyone know whether sterile water is hypotonic, isotonic, or hypertonic???? I can't find an answer to this question? I know we do all our flushes with normal saline, CBI with normal saline but there's a lot of confusion regarding sterile water?????? ANYONE???

[NRSKarenRN, BSN, RN]

Sterile Water Should Not be Given “Freely”

Sterile water is hypotonic (0 mOsm/L). Serious patient harm, including hemolysis, can result when it is administered by direct IV infusion....

Water can be replaced by mouth or nasogastric tube;

however, if given intravenously without additives to

normalize tonicity, hemolysis may occur

Help Hypotonic, Isotonic, & Hypertonic Solutions - 27th Nov, 10:47 ...

[Whispera, MSN, RN]

I agree, it's hypotonic.

[talaxandra]

If you think about what an isotonic fluid is, it makes sense - normal saline (or 0.9% sodium in water) is classified as isotonic because it has electrolytes at the same concentration as human cells.

This means that infusing the fluid doesn't cause radical shifts within cells as the body tries through osmosis to maintain the same level of osmolarity between the cell composition and the fluid bathing the cells.

If you instead infuse a fluid with a higher levels of electrolytes (like 3% saline), the cells shrink as the intracellular fluid rushes into the circulation.

Conversely, if you infuse a hypotonic solution (like water), the cells try to absorb extra fluid to match their environment, causing them to rupture, which is known as haemolysis.

There are some very rare situations where infusion a hyper- or hypotonic solution is appropriate, but in general IV flasks are manufactured to be isotonic with normal human biochemistry.

Normal saline is used for large volume bladder washouts (eg post-TURP) over sterile water as it may be absorbed into the blood stream and overload the patient (reference), but is used in theatre as saline interferes with safe diathermy (reference). That said, I always thought water irrigations damaged the cells lining the bladder wall, but I may be wrong. When googling this I found an article I couldn't access about a nurse who did a washout with diet Coke - if anyone can access it and post it I'd be delighted!

[MaryAnn_RN]

When googling this I found an article I couldn't access about a nurse who did a washout with diet Coke - if anyone can access it and post it I'd be delighted!

Here you are...

Mary

dietcoke.pdf

[talaxandra]

Thank you so much, Mary :) Especially as I spent half an hour trying to access ti through both my uni e-journal access and my work one, with no success - I was going to go past the work library on my way home this morning to dig out a hard copy (if we even subscribe to the journal). I love allnurses!

Although I suspected the nurse in question must have been reminded of using diet Coke to unblock a PEG... um, different physiological environment, sterility, and just general It's always good to have a reminder that, however urgent the situation seems, following protocol and asking for advice when you're out of your depth is a good thing!

[MaryAnn_RN]

It's a pleasure...wait till you read the article, and this was a 'senior' nurse.