Using Tap Water for Enteral Tube Flushes

Enteral feeding tubes, used in patients who require enteral nutrition or medication, require flushing between medications and feedings to maintain patency. Various types of water can be used to flush enteral feeding tubes, which raises the question of which type of water is best supported by evidence.

The aims of this quality improvement project were to examine the evidence on the use of tap water instead of sterile water for enteral tube flushes and to implement the use of tap water as a safe, cost-effective alternative to sterile water at a multisite oncology institution.

A systematic literature search of electronic databases including Scopus, PubMed, CINAHL, Google Scholar, Embase, and JBI was conducted to review current evidence and professional organization recommendations on the use of sterile water versus tap water in enteral feeding tubes. The oncology institution's policies were reviewed, and nurses were surveyed on the type of water they used for enteral tube flushes.

After the literature search and nurse survey results concurred that tap water was as effective as sterile water, the institution's nursing practice policy was updated to state that tap water should be used for enteral tube flushes, and that the use of sterile water for this purpose should be reserved for cases when there are concerns about tap water safety. This policy change was projected to incur annual sterile water cost savings of $15,930 to $19,872.

The implementation of a policy recommending the use of tap water for enteral tube flushes standardized clinical practice and decreased institutional costs while maintaining patient safety.