From the Guidelines
Free water flushes should be routinely administered before and after enteral feeding to prevent tube obstruction, as recommended by the ESPEN practical guideline on home enteral nutrition 1. When implementing free water flushes, several key considerations should be taken into account to ensure effective and safe practice.
- The volume and frequency of water flushes may vary depending on individual patient needs, but routine flushing before and after feeding is a crucial step in maintaining tube patency.
- Patient and caregiver education on the importance of water flushing is essential, as emphasized in the ESPEN guideline 1.
- Monitoring of the patient's fluid status and adjustment of the flush regimen as needed is critical to prevent complications such as dehydration or fluid overload.
- The use of room temperature water for flushing is generally recommended to minimize the risk of gastrointestinal discomfort.
- In patients with fluid restrictions, careful calculation of flush volumes as part of the total daily fluid allowance is necessary to avoid exacerbating fluid imbalance.
- Additional flushes may be required before and after medication administration to prevent drug-tube interactions and ensure effective medication delivery.
- The ESPEN practical guideline on home enteral nutrition 1 provides a valuable resource for healthcare professionals to develop evidence-based protocols for enteral nutrition management, including free water flushing practices.
From the Research
Free Water Flush Enteral Feeds
- The use of free water flush in enteral feeds is a topic of interest in the medical field, with various studies examining its effectiveness and safety 2, 3, 4.
- A study published in 2024 found that tap water can be used as a safe and cost-effective alternative to sterile water for enteral tube flushes, with potential annual cost savings of $15,930 to $19,872 2.
- However, another study from 2005 highlighted the risk of dehydration in long-term tube-fed patients, emphasizing the importance of careful evaluation and management of fluid intake and output 3.
- In the context of extremely low birth-weight infants, enteral sterile water feeds have been used to treat hypernatremia, although there is limited evidence-based research on this topic 4.
- The delivery of nutritional prescriptions via enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis has also been addressed, with clinical practice recommendations developed by the Pediatric Renal Nutrition Taskforce 5.
- Key considerations in the use of free water flush enteral feeds include:
- The type of water used for flushing (e.g. tap water vs. sterile water) 2
- The risk of dehydration and fluid imbalance in patients receiving enteral feeds 3
- The potential benefits and limitations of using enteral sterile water feeds in specific patient populations (e.g. extremely low birth-weight infants) 4
- The importance of individualized care and clinical judgement in the management of patients receiving enteral feeds 5