In "Drug Administration Through an Enteral Feeding Tube," Joseph I. Boullata states that sterile water must be used in medication administration because tap water "can and often does contain contaminants, including pathogenic microorganisms, pesticides, pharmaceuticals, and heavy metals that might interact with a drug and reduce its bioavailability" (October). Giving medications enterally is not a sterile procedure. The equipment is cleansed in tap water between administrations. Most hospitals flush the tube with tap water. If tap water is such a problem with medications, should we be giving oral drugs with sterile water? Should patients be allowed to drink their tea after taking medication? Where is the evidence to support this assertion?

The statement that medications given through an enteral tube should not be mixed uses an analogy to iv medications. This is not a similar situation. Comparing enteral medication to oral medications would be more apt. Must a patient take one pill at a time? How long must a nurse wait before allowing a patient to take a second pill? How does pouring one medication down an enteral tube, flushing, and then administering a second medication alter how they mix in the stomach?

Jane K. Brody, PhD, RN

Garden City, NY

Editor's note: The author declined to respond to this letter. However, Dr. Brody's questions are addressed in the 2009 Enteral Nutrition Practice Recommendations developed by the American Society for Parenteral and Enteral Nutrition (ASPEN). Joseph I. Boullata served on the task force that developed the guidelines, which are based on available literature and a consensus of expert opinion.