3 Reasons to Update Your Neonatal Enteral Feeding System

Evi Dewhurst / January 2016


Enteral feeding devices for neonates have had a tumultuous past. For many years intensive care enteral products only met the needs of adult or child patients. These products were then handed down to the NICU, where nurses felt dissatisfied with the lack of patient fit. Many nurses had to get creative with what they had and find a way to make the products work (I’ll bet many NICU professional readers know exactly what I’m talking about).

Thanks to NICU professional persistence and medical product designer inspiration, neonatal enteral feeding system components were soon recognized as a requirement. Solutions were created and the NICU finally began to receive what it desperately needed to support its very special, and very small, patient population in the last decade: appropriately sized and accessorized patient-specific tools, products and devices. NICU nurses everywhere rejoiced.

Improvements continued even after those milestones. For instance, neonatal enteral feeding has evolved to further reduce safety risk and improve nursing time.

That leads to 3 reasons you should update your neonatal enteral feeding system:

  1. Mismatched feeding components
  2. Slip tip connectors can be susceptible to error
  3. Lack of efficiency and versatility

#1: Mismatched feeding components

Just one look at a NICU storage room is enough to make any neonatal nurse break into hives. Perhaps that’s a bit extreme, but there’s no doubt that it does induce a mild anxiety. Different labels, an array of sizes, and many-use products, each with different purposes and serving diverse needs. Even the most experienced nurses hesitate in the storage domain, especially when something has been moved or changed. Why do nurses have such a reaction to the storage room? Safety. Each and every product in there must be used accurately and with precision. Patient safety is a priority, and if a product is used incorrectly it could lead to disastrous consequences.

What does this have to do with mismatched enteral feeding components? Just this: a piecemeal system using parts from multiple manufacturers could potentially cause safety issues or product mix-ups, as they will not visually or physically “go together” (talk about causing confusion in the storage room). Result in potential for disconnections (loss of milk) or misconnections (an adverse event) increases if enteral connectors do not use the same system, such as connecting a safety connector to a slip tip.

Make it a goal this week to look at your feeding components. Do your products fit together properly? Are they meeting the initial needs you had when you purchased them? Are they clearly marked for enteral safety? Does the full enteral system also have consistent markings for quick visual I.D. by your nurses, not only for patient safety, but also for nursing efficiency?

#2. Slip tip connectors can be susceptible to error

Slip tip connectors were once the primary enteral connector. They were standard and quite acceptable in the industry for their ease of use. However, over time safety issues came to the forefront which identified connectors as a point of misconnection and thus risk. In response, manufacturers began to create connectors with specific connection and locking mechanisms to avoid the risk of enteral tubing misconnection to medication tubing.

As years passed, governmental and health agencies become involved in mandating enteral connector safety efforts. These agencies recommended steps for a safe solution in 2014 (for all small bore connectors, in fact) and included Association for the Advancement of Medical Instrumentation (AAMI), International Organization for Standardization (ISO) and the Food and Drug Administration (FDA). The Global Enteral Device Supplier Association (GEDSA) was created for the sole purpose of helping manufacturers create a universal safety and locking enteral feeding connector. The result was the ENFit connector, which is currently available from a few neonatal enteral feeding manufacturers, including Medela. Look closely at ENFit neonatal enteral connector products or others (such as the TwistLok connector) which were designed specifically to minimize I.V. luer misconnections.

If you are still using slip tip enteral feeding connectors, now is the time to look at your options. It’s not a matter of “will a misconnection happen” – it’s a matter of when. You’ll certainly agree that it is never worth the risk.

#3. Lack of efficiency and versatility

As if nurses didn’t already have enough to do, they must also engage in a balancing act between patient care and nursing efficiency. Every patient, and every minute, counts.

Let’s return to our #1 reason to update your neonatal enteral feeding system – mismatched components. What do you think takes more time for nurses in the NICU when preparing an enteral feed: (A) Cobbling together enteral feeding products which do not match visually or fit together properly, or (B) Assembling enteral feeding products with similar markings, colors and matching connectors? I think it’s safe to guess you would answer (B). That answer offers the most efficiency.

Take the time to list out areas of grief in your unit. Are there certain enteral products which take up too much nursing time? Take time away from patients? Warming is a good example. If you are still using the cup and water method, it might be time to look at waterless warming, which reduces potential for waterborne pathogen exposure, improves warming technique to preserve micronutrients and increases nursing efficiency.

How about versatility? Look at your current enteral feeding system and ask how versatile the products are. Can your pump feed syringes be used for gravity feeding (as a closed system, no gauze needed)? Can your gravity feeding syringes work for venting (and contain fluid before it soaks the sheets)? How about your milk warming… Can it be moved with ease around the room to meet patient and clinician needs? Many neonatal enteral products in recent years have been designed to offer versatility to NICU professionals and save them time, while increasing patient safety.

More than ever, the NICU has access to neonatal-specific enteral feeding products. Now is a great time to assess your neonatal enteral feeding system needs. Simply by reviewing and making necessary changes to your NICU enteral feeding system, you can better position your unit to achieve success with patient outcomes, safety and nursing efficiency. And a bonus: it just might make your storage room a little less intimidating.


Looking for more articles like this? Read “Medication Safety and ENFit Connectors.”