From the Guidelines
Free water flushes are essential for patients receiving enteral nutrition to maintain hydration and prevent tube clogging, and the most recent evidence recommends using at least 30 mL of water for irrigation when giving medicines or when flushing small diameter nasogastric tubes. For standard enteral tube maintenance, administer 30 mL of water before, between, and after each drug, as well as before and after each feeding, as recommended by the ESPEN guideline on home enteral nutrition 1. The use of free water flushes helps maintain tube patency by preventing formula and medication residue buildup, reduces the risk of tube occlusion, and contributes to the patient's overall hydration status. Regular flushing also helps prevent bacterial colonization of the tube and ensures complete medication delivery.
Key Considerations
- Total daily free water requirements typically range from 1-1.5 liters, but should be individualized based on the patient's fluid needs, medical condition, and electrolyte status.
- Use room temperature water rather than cold water to prevent cramping.
- Sterile water is recommended for immunocompromised patients, while tap water is generally acceptable for most patients.
- For patients with fluid restrictions, the volume and frequency of flushes may need adjustment in consultation with the healthcare team.
Evidence-Based Recommendations
The ESPEN practical guideline: home enteral nutrition also supports the use of routine water flushing before and after feeding to prevent tube obstruction 1. Additionally, the guideline emphasizes the importance of adequate flushing of the tube between feed and/or medications to reduce the risk of tube occlusions and drug-drug interactions 1.
From the Research
Free Water for Enteral Flushing
- The use of free water for enteral flushing is supported by evidence, as seen in the study 2, which examined the use of tap water instead of sterile water for enteral tube flushes.
- This study found that tap water was as effective as sterile water for enteral tube flushes, and the institution's nursing practice policy was updated to reflect this, resulting in significant cost savings.
- The study 2 also noted that the use of tap water for enteral tube flushes standardized clinical practice and decreased institutional costs while maintaining patient safety.
- There is no direct evidence in the provided studies 3, 4, 5, and 6 to support or refute the use of free water for enteral flushing, as these studies focused on the effects of metoclopramide on gastric emptying and motility in various patient populations.