Sterile Water for Enteral Feeding Tubes?

[med_geek]

Hi all, I have a question about what type of water you use for flushing and administering meds via NG/OG tubes. At the ICU in the hospital I am currently at, we are required to use sterile water ONLY. However, the rest of the hospital uses regular tap water. The theory is that critical care patients are often immunocompromised and so have a higher risk of acquiring an infection from tap water than other patients. I find it much easier to dissolve crushed meds in warm water (which is impossible when using sterile water). I have been looking into nursing journals for research, but I was curious as to what you do on your units.

Thank you in advance!

[sapphire18]

jouRNey8 said:

I've seen brown water come out of our taps before...going to stick with the sterile water for now.

?!?!?

[Cinquefoil]

The reasoning I've heard is that the interactions between the water additives in community water sources, and medications, are not well studied. Safest therefore to use sterile water which is, in theory, JUST water.

I take this with a grain of salt because what about people who just drink liquid meds with tap water? Or what about the substances leaching out of the plastic bottles? But yeah if your tap water is brown then I'd go sterile too [emoji15]

[Nalon1 RN/EMT-P, BSN, RN]

Cinquefoil said:

The reasoning I've heard is that the interactions between the water additives in community water sources, and medications, are not well studied. Safest therefore to use sterile water which is, in theory, JUST water.

I take this with a grain of salt because what about people who just drink liquid meds with tap water? Or what about the substances leaching out of the plastic bottles? But yeah if your tap water is brown then I'd go sterile too [emoji15]

Well just as you have said, if the water is bad, it is probably bad where the pt is and they drink it all the time.

Plus, I am trying to think of what would be in tap water that would interact with medications?

[nursemcsleepy, BSN, RN]

Sterile, but I work in BMT and our patients aren't allowed to drink tap water, so it makes sense. I think most of the rest of the hospital uses tap.

[Greenclip]

We are supposed to use sterile water in the ICU. Many of us are very lax about following that policy, for all the reasons stated above...the gut isn't sterile, you aren't using new sterile equipment each time.

It makes sense to me to use sterile water in a BMT unit.

[NotReady4PrimeTime, RN]

We use sterile water - the kind that comes in 59mL plastic bottles from our infant formula supplier. But it's just for convenience. Many of our open beds don't have ready access to running water so it's just easier to keep a little bottle on the bedside cart. It's not a policy.

[CCU BSN RN]

Tap water for the reasons above

But if I lived in Flint, MI or something, I'd probably be inclined to use sterile water.

[akdennis123]

Sterile Water for Irrigation, USP, is not only sterile but it is also DISTILLED. When you give this sterile water you are giving DISTILLED water. For this reason, I am against the use of this in the enteral route. It is extremely hypotonic and has the potential to dilute blood mineral concentrations, like sodium and potassium and the others, and 2) cause mucous membranes to swell. The tonicity of normal saline is about 310 mOsm/L. The tonicity of Sterile Water for Irrigation, USP is 0 mOsm/L. There are articles and papers online that caution against using it in the enteral route.

[ruby_jane, BSN, RN]

AngelRN27 said:

The gut is not sterile, so I'm not sure how effective using sterile water for NG/OG tubes would be. Did those of you who use this method at your hospitals have some sort of evidence-based back up for this practice?

This may be one of nursing's sacred cows. Do what the policy says....and know that at home and in the community, we're using tap water or non-sterile bottled water unless there's a reason not to.

[NotReady4PrimeTime, RN]

I wish more people KNEW that those 500mL bottles of sterile water are not the benign things they think they are. But most people don't even think about it. In peds we have the advantage of bottled water for oral use - the bottles only hold 59mL so using them for free water in larger tube fed patients is a little time consuming, and could be more expensive, but much better for the patient.

[CowboyMedic, DNP, APRN, CRNA]

We use either sterile water or tap water. I haven't been told not to use tap water on patients except for immunocomprimsed patients. Now Neuro patients are a different story since I work in a Med-Surg-Neuro unit. We will get some patients that are on Triple H therapy (Hypertension/Hypervolemic/Hypernatremic) for SubArachnoid Hemmorages or ICP managment. In those cases it is sterile NaCl only.

[Pheebz777, BSN, RN]

Do you guys use sterile gloves when bathing patients too? No harm using sterile gloves. No harm in using sterile water as well.

But the water we use is from the water dispenser. Not faucet water.