Susan Hepworth and Mitchell Goldstein, MD
Tubes deliver food, medicine, and blood or other liquids to tiny patients in neonatal intensive care. Mixing up the various tubes could lead to serious injury, even death. So in the mid-2000s, experts called for a new style of feeding tube connector to reduce tubing misconnections.
In response, the ENFit style connector debuted in 2014. Its “male” feeding tube connectors are only compatible with “female” syringe tubes. While the design reduces the likelihood of tubing mix-ups, it ushered in a new issue.
According to researchers, the ENFit tubing connector “significantly increases the opportunity for inaccurate dosing.” These findings support existing concerns. Some health professionals and patient advocates have raised the issue with the product itself, citing safety and workflow problems. Others are apprehensive that it is being forced into use in some places, such as California. Now, there is evidence to support the unease.
Medicine can “hide” in the area around the syringe barrel of the ENFit connector. If this “moat” is not cleared properly, too much medicine can be administered. Even a small amount of excess medicine puts these tiny infants at risk of overdose or adverse drug reactions.
The ENFit design also increases the potential for bacteria to colonize if residual breast milk or formula remains in the moat. This design could introduce infection, which could also have dire consequences.
While peer-reviewed evidence supporting dosing concerns had been lacking, that is no longer the case. After completing 576 tests, researchers at UF Health affirmed dosing inaccuracy. They also commented about the usability of the ENFit connectors and adapters, stating nurses and caregivers need “extensive training” to learn “how to appropriately use” them.(1)
The research shows: Patient safety is on the line. The new findings support calls from the National Coalition for Infant Health and others to ensure hospitals and health care centers are fully informed about the ENFit dosing connectors before using them.
References:
- O’Mara K, Gattoline SJ, Campbell CT. Female low dose tip syringes-increased complexity of use may compromise dosing accuracy in paediatric patients. J Clin Pharm Ther. 2019. https://doi.org/10.1111/jcpt.12810
The authors have no relevant disclosures.
Corresponding Author
Susan Hepworth
Director
National Coalition for Infant Health 2020 K Street NW
Suite 505
Washington, DC 20006
Email: info@infanthealth.org
Mitchell Goldstein, MD
Professor of Pediatrics
Loma Linda University School of Medicine
Division of Neonatology
Department of Pediatrics
mgoldstein@llu.edu
National Coalition for Infant Health Values (SANE)
Safety. Premature infants are born vulnerable. Products, treatments and related public policies should prioritize these fragile infants’ safety.
Access. Budget-driven health care policies should not preclude premature infants’ access to preventative or necessary therapies.
Nutrition. Proper nutrition and full access to health care keep premature infants healthy after discharge from the NICU.
Equality. Prematurity and related vulnerabilities disproportionately impact minority and economically disadvantaged families. Restrictions on care and treatment should not worsen inherent disparities.