EBP Project Abstract
Appraised by:
Karalyn Klipfel (SN), Jessica Lybeck (SN), Kim Pritchett (SN)
NDSU Nursing at Sanford Health, Bismarck, ND
Clinical Question:
In critically ill/ immune compromised patients does using sterile water versus tap water in medication administration via enteral feeding tube decrease the risk of infection?
Articles:
Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., …Wessel, J. (2009). Enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition, 33, 122-167.
Padula, C. A., Kenny, A., Planchon, C., & Lamoureux, C. (2004). Enteral feedings: what the evidence says. American Journal of Nursing, 104, 62-69. Retrieved from
Schloerb, P. R., Wood, J. G., Casillan, A. J., Tawfik, O., & Udobi, K. (2003, October 9). Bowel necrosis caused by water in jejunal feeding. Journal of Parenteral and Enteral Nutrition, 28, 27-29. Retrieved from
Synthesis of Evidence:
As stated by (Schloerb, Wood, Casillan, Tawfik, & Udobi, 2003), a number of patients, as well as animal studies, are supporting a 1940 findings by Dennis that point toward distilled and normal saline, in the cases described the patients presented with different issues but the common factor between them was the use of water jejunal feedings. The previous and current findings are “cause is unclear and that the pathophysiology seems complex.” Therefore the article recommended that distilled or tap water can injure the small bowel thus resulting in complications. It is recommended that normal saline be used over distilled or tap water.
Padula, Kenny, Planchon, & Lamoureux,( 2004) created a new set of guidelines for enteral feeding procedures and policies to decrease the rate of infection and complications in the critically ill and immunocompromised patients receiving enteral nutrient. They determined there was a variety of things that can be done to decrease infection and complications such as washing hands. Wearing non-sterile gloves and tap water may be used if the safety is determined, otherwise sterile water should be used in the immunocompromised and the critically ill, among many other guidelines. The research and the guidelines this institution adapted were based on the research.
The Enteral Nutrition Practice Recommendations Task Force (Boullata et al., 2009) examined the literature that was available relating to enteral feedings ordering, preparation, delivery and monitoring of them and also to establish evidence-based practice guidelines that deal with types of water to be used in enteral feedings, hang times, and the stability of the feedings..
Although there is controversy between using sterile water over tap water, it has been recommended that sterile water should be used with medication administration in the critically ill/ immunocompromised. This change would decrease the chance of infection which would, decreased patient length of stay, and thus decreasing medical costs.
In the research we found different types of studies researching this topic. We found several guidelines which recommend the use of sterile water. These studies have been done in different areas of the hospital and labs which included both animals and humans, both yielding the same results.
Bottom Line (findings):
Using sterile water for enteral medication administration has been shown to decrease the chances of infection compared to tap or distilled water. By using sterile water,patient’s clinical outcomes may be improved and length of stay may decrease. There have not been any adverse effects reported with using sterile water.
Implications for Nursing Practice:
Practice recommendations would include developing a policy to use sterile water when administering enteral medication. Sterile water is shown to be more safe and effective than tap or distilled water.