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|Newsletters: Enteral Connector Changes: FAQs for Blenderized Diet & Other Patient/Caregiver Concerns|
Enteral Connector Changes: FAQs for Blenderized Diet and Other Patient/Caregiver Concerns
Tom Hancock, GEDSA
The Oley Foundation received a good deal of mail in response to the article in the January/February newsletter called "New Connectors for Enteral Feeding Tubes.” The article outlined changes that are being implemented to reduce the possibility of tubing misconnections.
Tom Hancock, who wrote that article, has addressed some of those questions for us. If you have additional concerns or questions, please send them our way and we will share them with Tom. Details also available at www.stayconnected2014.org.
Will low-profile (skin-level) gastrostomy tubes (G-tubes) be changed?
Connectors on low-profile feeding tubes are out of scope of the new design standards and will not be changed. Extension sets used with low-profile G-tubes will have the current connector on the end that is inserted into the G-tube, and the new ENFit connector on the end that connects to administration sets and syringes.
Why does this new system require that the old system become obsolete?
The goal of establishing an EN connector design standard is to improve patient safety by reducing the risk of a tubing misconnection, which is rare but dangerous and can even be fatal. The most effective way to reduce the risk of misconnections is to ensure that connectors of different delivery systems (i.e., EN and IV) are not compatible. Also, patients today are typically quite mobile, moving between hospital, post-acute facilities, and home. If each setting used feeding devices with either old or new connectors, there is a strong likelihood of disruption of therapy due to incompatibility, as well as potential for a misconnection.
Will the new connectors allow for venting?
Yes, venting will work in the same manner it does currently. Note that venting a feeding tube that has an ENFit connector will require a syringe that has an ENFit connector.
Will it be possible to hydrate with a catheter-tip or oral-tip syringe?
To hydrate through a feeding tube that has an ENFit connector, you will need a syringe that has an ENFit connector. Catheter-tip and oral-tip syringes will not fit ENFit connectors. The ENFit connector was designed specifically to prevent the use of catheter-tip syringes in order to reduce the risks associated with misconnection among medical delivery systems. Syringes with the ENFit connector will be available in advance of feeding tubes with the ENFit connector.
Will thicker formulas and blenderized foods pass through the new ENFit connector?
The new EN feeding design standards were developed with current practice in mind and specific requirements to avoid any disruption of therapy. The bore size (or hole) in the ENFit connector was designed to be consistent with the bore size of the current connector, and feeding through devices with these connectors is intended to be consistent with current practice. For more information, contact the manufacturer of the EN device in question directly.
Will there be adapters? Will they fit different kinds of syringes?
During the transition period, a transition connector that will be compatible with the new EN-specific syringe will be available. The adapter (or transition connector) will make the new syringes compatible with current feeding tubes. After the transition period, you will not need an adapter to fit an ENFit syringe to an ENFit feeding tube. As noted above, catheter-tip or oral-tip syringes will not work with the new ENFit connector feeding tube. [Editor’s note: Sometimes catheters that are not designed for EN are placed as feeding tubes (for example, a Foley catheter). GEDSA advises against and cannot address any off-label use.]
Will using a transition connector on a bolus extension set make the hole in the bolus extension–syringe connection smaller?
Yes, the hole on the transition connector will likely be smaller than that in the catheter-tip syringes currently in use, but it won’t be smaller than the end of the extension set that connects to a low-profile device. As long as the end of the extension set remains the smallest hole in the system, the flow rate properties are not expected to change from the current configuration.
Will bolus syringes used for feeding blenderized diets be available with the ENFit connections? Will the hole at the tip of the syringe be smaller, and will this impact the ability to feed?
All syringes intended for use with EN feeding tubes in the future will require the new ENFit connector. EN-specific syringes with the ENFit connector will likely have a smaller hole than the catheter-tip syringes currently in use. However, the hole will not likely be smaller than the opening on the patient access end of the (bolus) extension set on most low-profile devices. As long as the end of the extension set remains the smallest hole in the system, the flow rate properties are not expected to change from the current configuration. For other devices (i.e., non–low-profile), the industry is currently evaluating the impact of a smaller size of the hole.
Will there be color-coded EN syringes available to manage medication administration?
There are no color-coding requirements in the standards. Syringe manufacturers may offer EN-specific syringes in one or more colors.
Will pharmacies stock EN syringes?
Distributors and pharmacies will be alerted of this potential need, but ultimately it is up to the pharmacy to decide to carry these items. Check with your local pharmacy, home medical equipment supplier, or home care company about the availability of EN-specific syringes.
Once syringes are EN-specific, will there be greater insurance coverage?
GEDSA and its manufacturer and supplier members are not in a position to address issues related to insurance coverage or reimbursement. Check with your insurance provider for their specific policy.
What about non-traditional use of EN patient access devices?
GEDSA advises against and cannot comment on or address any off-label use.
GEDSA note: All products and product designs are the responsibility of each manufacturer, distributor, or supplier. Products with the ENFit design features may be pending regulatory clearance or may not be available in certain areas. Consult your supplier representative for product-specific use, availability, indications, contraindications, precautions, and warnings. This material is intended for informational purposes only and should not be used to replace regulatory or company-specific documents, nor should it replace the advice of a qualified professional.
Timeline for New Connectors (US, Canada, Puerto Rico)
4th quarter 2014: Feeding/administration sets with ENFit connectors available
LifelineLetter, May/June 2014
2/6/2017 » 2/10/2017
Feeding Tube Awareness Week
2/18/2017 » 2/21/2017
Oley exhibit at A.S.P.E.N.'s Clinical Nutrition Week
Oley Regional Conference