Cleaning ENFit in the NICU: What You Need to Know
Kathleen Quellen, RN, BSN / October 2019
If you’ve converted your NICU enteral feeding devices to ENFit connectors, you may have questions about proper cleaning techniques. Or, perhaps you are considering converting, but have concerns about cleaning the feeding tube hubs. Stay with me, because I’ve got your answers!
The ENFit design, with male/female ports reversed from standard set up and also a locking system, was created to avoid misconnections. The goal was to ensure the ENFit ports could not fit into a non-enteral line. While this was a positive, much needed step, it did involve some practice change.
Why cleaning technique had to change
Switching the male/female configuration and having a locking system meant the feeding tube end was now male, and the syringes and extension set ends were female. As a result, the NGT end had a “moat” around it to accommodate the male connector and the locking system.
The issue with having this “moat” is cleaning. Milk can build up in that area, dry up, and sit for several days. I know what you’re thinking – milk build-up could allow for the possibility of infection, since feeding tubes can be in place for up to 30 days. Even changing feeding tubes every 7 days, which many facilities now do, could still be more than enough time for bacteria to grow.
Some ENFit products have open holes within the “moat” to allow milk to drip through. Unfortunately, milk can still stick to the sides, and the drip has to go somewhere – likely onto the NG tube and bed.
Prevention: The best solution
I’ve included details about cleaning methods below, but let’s start with the simple tactic of prevention. Prevention is always the best medicine.
Here’s how: Do not overfill the syringe, or fill to the end of the tip. Simple, right? That’s the best way to avoid having milk spill over into the moat area on the NGT.
There’s another step that involves a simple and easy-to-implement practice change. While most nurses bring the syringe down to the NGT, with ENFit it’s best to bring the end of the NGT to an upright syringe and reverse what was done in the past. The old way of bringing the syringe into the moat of the NGT could cause milk to spill over into the area.
Education makes a difference
Education that provides in-servicing and posters for the first few weeks after an ENFit conversion is the best way to assist in practice change. Also, nurses seeing the buildup of dried milk when not following these steps is a powerful visual reminder to reverse old habits.
You can use prevention and education to avoid the milk moat issue, but what if you still need to clean?
Luckily, the Global Enteral Device Suppliers Association (GEDSA, the original designers of ENFit) provides a cleaning chart. It involves having gauze, sterile water, syringes, and toothbrushes as cleaning tools to remove dried milk. If your facility is converting to ENFit, I’d recommend having those supplies ready. Plan to teach cleaning along with prevention techniques.
There are several ENFit cleaning brushes offered from various manufacturers, but they may be cost-prohibitive. The same results can be achieved with a toothbrush or gauze and water. Have your facility look at all options and decide what works best for you.
Removing dried milk from the small space within the “moat” of the NGT hub is not easy, and I’d like to stress this as another important reason to promote “prevention is the best medicine.” Work with clinicians to practice not overfilling and reversing how they used to connect to hubs.
Some last suggestions for ENFit cleaning:
- Work with your manufacturers on assisting your clinicians with education
- Talk to other hospitals that have done ENFit conversions, and ask how they worked through cleaning issues
- Discuss protocols for cleaning with ENFit hospitals. Do your own research on cleaning and discuss with staff what will work for them.
- Most importantly, if possible, have an ENFit cleaning plan in place before you convert, and avoid any consequences from improper cleaning and milk build-up
A little more preparation getting a cleaning plan in place can make your conversion successful, or address cleaning issues you may already be working through. I’d enjoy hearing from you. Tell me how your ENFit cleaning plan is going by commenting below!
Learn more about Medela’s ENFit enteral feeding solutions
About the Author
Kathleen Quellen, RN, BSN, has been a NICU/PICU RN since 1981. She has worked in hospitals all over the U.S., including Georgetown University Hospital, DC Children’s, Cedars Sinai and Children’s Hospital of NJ. She worked as a Clinical Specialist for Abbott Labs/Hospira and has been a NICU Clinical Specialist for Medela LLC since 2014. She covers hospitals all throughout the western United States.