5 Reasons to Finally Change Your NICU Enteral Feeding System

Evi Dewhurst / August 2016

Do the words “good enough” fit your neonatal enteral feeding system?

Perhaps you’ve wanted to advance change in your NICU but were told other projects were a priority. Maybe it was the value analysis committee that slowed your momentum. Or the idea that time was just too limited right now to invest in such a conversion.

To add to the decision difficulty, enteral feeding has a cobbled history of products: new connectors here, a change of color there, priming volume variances, medport options, length of tubing, tubing material, neonatal products versus adult… This, in combination with any of the other reasons listed above, compounds the holdup. It’s why some NICUs still make do with a variety of products from differing resources and avoid the update dilemma altogether. “It’s good enough,” you might think, with a wish for the day it can finally change.

That day has come.

Here are five reasons to help make a change to your enteral feeding system: Reasons for you, reasons for the VAC, reasons for your hospital.

  1. Mismatched enteral feeding products can become a safety hazard.

If your NICU is still using different products from multiple different manufacturers, the likelihood of a misconnection is higher. These products do not resemble each other in color, connectors, or labels. I’ve seen some neonatal intensive care units use as many as three or four different manufacturers for syringes, various extension sets, and feeding tubes.

This can happen over time as new decision-makers come in, or because one specific product seems to be better or is easily adopted. It’s also more common in the smaller NICUs, who may not have the clout within their hospital to demand higher-grade, updated products.

It’s time to address this as a safety issue and convince your hospital purchasing and leadership that change must be made to benefit patient safety and clinical effectiveness. Cobbling together enteral feeding products for such at-risk infants is a practice that should be minimized where possible, especially when considering the priority of patient outcomes.

  1. Regulatory agencies recommend specific safety standards which older enteral feeding products may no longer meet.

The Joint Commission, American Dietetic Association and more have specific guidelines for safe enteral feeding practices. While these guidelines have been in existence for many years, they have experienced updates and new developments while advances have occurred. Here are a few of the current standards:

The Joint Commission

  • “Use tubing and related equipment only as they are intended to be used.”
  • “Never use standard luer syringes for oral medications or enteral feedings.”
  • “Do not use IV tubing or IV pumps for enteral feedings.”

American Dietetic Association

  • “Unique tubing for enteral feedings-e.g., one with a unique color and connector designed for feeding tubing-is strongly suggested.” – American Dietetic Association, 2011, p. 99

Additionally, the Joint Commission, American Society for Parenteral  and Enteral Nutrition (ASPEN), International Organization for Standardization (ISO), Association for the Advancement of Medical Instrumentation (AAMI), and Global Enteral Device Supplier Association (GEDSA) have in recent years collaborated on new standards for enteral connector specifications in order to prevent misconnections to other application device connectors. These specifications have brought about the ENFit® enteral connector, which is already available and in use. The FDA recognizes the ISO and AAMI recommendations for these specifications.

  1. Neonatal intensive care patients have different requirements than adult patients.

We’ve heard the stories from early neonatal care: NICU nurses forced to rely on creative solutions to meet the needs of their infant patient population because neonatal products just didn’t exist. Fortunately, innovation has advanced enough in these modern times to address the needs of these smallest and most vulnerable patients.

Enteral feeding components specifically designed for neonates are readily available. Not only are they appropriately sized, but they also offer versatility in product offerings to meet the needs of your specialized infants. Aside from the usual tubing with smaller priming volumes, these include milk warmers, milk straws to avoid dunking syringes, and efficient gravity feeding syringes which prevent spills.

If you’re still using products designed for larger patients, you’ll find that transitioning to neonatal-focused feeding products will be a welcome benefit to your patients and nursing staff.

  1. Training and conversion for enteral feeding products can be more efficient than you think.

Time and efficiency are a true dilemma in healthcare. Why is this? There is never enough time, and efficiency can be compromised by unforeseen variables. Healthcare professionals are under extreme pressure to accomplish much with little. No wonder the idea of adopting new products is so overwhelming.

Yet of all products, enteral feeding may be one of the easiest and fastest products to adopt. Your NICU nursing staff is already proficient in the enteral feeding process, after all. Taking on new enteral feeding products for improved safety, tubing connectors, innovation, or nursing efficiency does not take as much adoption and training time as more complex technology.

If the time investment concern is holding you back, try asking your NICU enteral feeding product provider about implementation time. The answer just might surprise you. An added benefit: many of these providers offer additional education which will not impede your nurses. Rather, it will benefit your overall practice with minimal impact to nursing time.

  1. Newly regulated enteral feeding connectors are becoming law.

California has already enacted a law as of July 1, 2016, stating that healthcare medical tubing connectors must not have the ability to connect to other application tubing (i.e. enteral feeding tubing connectors must not be able to connect with IV medication delivery connectors, etc.).  The ENFit connector meets California law criteria.

How long will it be before this decision in California impacts neighboring states? Or the entire country? Clearly the law was created with the intention to improve patient outcomes and reduce error. These are worthy goals for any healthcare system and many other states will swiftly recognize it.

Additionally, large health systems with facilities in California may adopt these connectors into their entire system – including any state their facilities reside in.

If your NICU is not already using or investigating enteral connectors which prevent misconnections, then now is a good time to begin your research.  Educate your senior leadership on the facts and benefits of using something like the ENFit enteral connector to prevent potentially deadly misconnections.

Change is hard. Especially in healthcare. As a champion for your unit, your team, and your patients, take these five supporting reasons for change and become a force for progression in enteral feeding. At some point down the road, you’ll wonder what ever in the world held you back.

We’d love to hear from you in the comments below. Let us know: What efforts have you engaged in to drive change in your NICU?


The Joint Commission. (2006, April) Managing risk during transition to new ISO tubing connector standards. Sentinel Event Alert, Issue 53. Retrieved from www.jointcommission.org

American Dietetic Association. (2011). Infant Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities.

About the Author

Evi Dewhurst is a Senior Marketing Manager for Medela, Inc. As a proud mother of two young children, she is passionate about healthcare for youngsters everywhere and has a serious soft spot for babies. She is part of the dedicated team at Medela, who together are committed to designing and manufacturing products to advance human milk healthcare. Have a question? Evi can be reached at evi.dewhurst@medela.com