ENFit Conversion and the Impact on Oral Medication Delivery in the NICU/PICU

What is ENFit?

ENFit^® is the registered trademark name commonly used for ISO 80369-3 connectors and was designed for enteral feeding safety. Some manufacturers, like Medela, have adopted the ENFit^® name to use on devices that are made with the ENFit^® connector system. This design eliminates inadvertently connecting to anything other than an enteral feeding line.

ENFit Conversion and the Impact on Oral Medication Delivery

While the ENFit design was meant for enteral feeding, it can inherently affect medication delivery. It is vitally important that a hospital take into consideration options that increase patient safety, but not trade one issue for another. As pointed out by the National Coalition for Infant Health, “pediatric providers must deliver medication in small volumes to tiny patients with high levels of accuracy. The new tubing design, known as ENFit^®, could present dosing accuracy challenges…”

1 mL ENFit Syringe

Legacy Oral Syringe

As you can see from the pictures: an ENFit^® syringe can be delivered into an ENFit^® feeding tube but, if it is to be administered orally in a neonate or toddler’s mouth, the larger, threaded tip and moat area can affect not only administration, but accuracy.

As a NICU nurse, there were many times when myself and my colleagues had to explain why options, products, care, and more had a different impact on the neonatal and pediatric population as compared to the “rest of the hospital.” The ENFit^® design is something that needs to be taken into consideration with oral medication administration when it comes to the delicate intricacies required in smaller patients.

Example Scenario

Patient is a 6-day old, 36-week neonate, weight 3kg, diagnosed with Neonatal Abstinence Syndrome. Physician orders Morphine 0.05mg/kg/Q4H. Concentration 2mg/ml. Dose for this patient = 0.075mg Q4H.

Medication is delivered to the NICU in an ENFit^® syringe. Because of its larger, threaded tip, the nurse places an adapter on the tip of the syringe to easily administer into the neonate or pediatric patient’s mouth. The dead space on adapters that do not incorporate low-dose technology increase the risk for inaccurate doses as described in the two studies below.  

According to research published in the Journal of Clinical Pharmacy and Therapeutics, the ENFit tubing connector “significantly increases the opportunity for inaccurate dosing.”

1. Female low dose tip syringes-increased complexity of use may compromise dosing accuracy in paediatric patients
   • clinical concerns of dosing accuracy
   • the impact of low-dose tip syringes with adapters, compared to legacy devices

Objective:  Evaluate the frequency of dosing variance exceeding 10% of the intended dose between legacy and female low-dose tip syringes.

Results:  Significantly higher rates of unacceptable dosing variance compared to legacy syringes. This higher dosing variance occurred with the low-dose tip in 0.5ml and 1ml syringes.

2. Dosing inaccuracy with enteral use of ENFit ^® low-dose tip syringes: The risk beyond oral adapters
   • Compare the performance of ENFit^® low-dose tip syringes when used for enteral medication administration to the syringe performance during oral administration conditions. 

Objective:  Compare the performance of the ENFit^® low-dose tip syringes when used for enteral medication administration to the syringe performance during oral administration conditions. 

Results:  Using low-dose tip syringes for the enteral route resulted in higher rates of unacceptable dosing variance >10% when compared to oral application. 

ENFit^® was not intended for the pharmacy. The ISMP recommended oral syringe tip is safe, accurate, and engineered incompatible with IV lines. This makes slip-tip oral syringes the ideal solution for administering oral medications, as mentioned in the patient scenario above, while mitigating the risk of inaccuracies. 

It is important that oral medication delivery is taken into consideration prior to making the transition to ENFit^®. Medela’s focus is on the neonate, and the complexities this patient population brings to the vast array of clinical areas within a health system. 

Implementing ENFit^® is something that needs to be taken seriously. For options that incorporate enteral feeding safety while maintaining safe, accurate delivery of oral medications, please visit the Medela LDDC solution and contact your Medela representative.  

Medela specializes in moms and babies. Our focus lies where details matter.

References

1. GEDSA.  2021. May 5, 2021. {stayconnected.org/} 
2. National Coalition for Infant Health.  Tubing Safety Resources. May 5, 2021.  {infanthealth.org/tubing-safety}
3. O'Mara, K., Gattoline, S. J., & Campbell, C. T. Female low dose tip syringes-increased complexity of use may compromise dosing accuracy in paediatric patients. Journal of clinical pharmacy and therapeutics. 2019;44(3): 463–470. doi.org/10.1111/jcpt.12810
4. O'Mara, K. & Campbell, C. T. Dosing inaccuracy with enteral use of ENFit^® low-dose tip syringes: The risk beyond oral adapters. Journal of clinical pharmacy and therapeutics. 2019;00:1-5. onlinelibrary.wiley.com/doi/10.1111/jcpt.13079