Free Water Administration Through Nasogastric Tubes
Flush nasogastric tubes with at least 30 mL of drinking-quality water before and after each feeding to prevent tube obstruction, or every 4 hours during continuous feeding. 1
Standard Water Flushing Protocol
The most critical aspect of free water administration through Ryle's tubes is routine flushing to maintain tube patency:
- Administer at least 30 mL of water before starting feeds 1
- Administer at least 30 mL of water after completion of feeds (for bolus administration) 1
- Flush every 4 hours during continuous feeding 1
- Use water of drinking quality for all flushes 1
This flushing protocol is essential regardless of whether the tube is used for gastric or jejunal feeding, as tubes are prone to blockages due to protein-rich solutions, fluid viscosity, and small lumen diameter. 1
Additional Free Water for Hydration
Beyond tube maintenance, free water can be administered for hydration purposes, though the amount varies widely based on individual patient needs:
- Patients on tube feeds receive variable amounts of added water (ranging from 0-1000 mL per day in pediatric studies) 2
- Water administration modifies feed viscosity and can impact clinical outcomes 2
- Consider the patient's total thin liquid intake when determining free water amounts, as higher percentages of thin liquids (>20% of total intake) may be associated with increased chest X-ray requirements in some populations 2
Clinical Considerations for Water Administration
When administering medications through the tube:
- Adequate information should be provided to patients and carers with pharmacist involvement 1
- The tube should be flushed before and after medication administration to prevent interactions and blockages 1
Important caveats:
- The longer the feeding tube and the more medications administered through it, the greater the risk of blockage 1
- Proper flushing technique is a fundamental part of patient and carer education 1
- Free water administration should be part of the overall fluid management plan, considering the patient's hydration status and nutritional requirements 1