ENFit Low Dose and Medication Administration
Kathy Quellen, RN, BSN / April 2018
Enteral feeding is changing. Make sure you’re ready with the right solutions.
ENFit is the new enteral feeding design created with the goal of avoiding misconnections. To prevent enteral feeding misconnections with IV connectors, the male/female hubs were switched. The syringes are now female (with larger tips) and the tubing (extension sets, feeding tubes) have male connectors. It is recommended that enteral feeding systems be locking (as ENFit is). Slip tips will eventually phase out.
These updates may have brought about new feeding practice changes in the NICU, but medication administration with ENFit is impacting both clinical areas and pharmacy.
It’s important for clinicians to understand these changes, and how certain solutions can alleviate the pain of change.
I’ve broken down the highlights from these two perspectives: nursing and pharmacy.
There is a one particular concern from the nursing side that is completely understandable. That concern is the new ENFit syringe female tip. The tip is much larger than a standard syringe, and many clinicians feel it is too large to put into a neonate’s mouth.
That large tip can be avoided by using solutions that have smaller tips for medication administration. Important to note is that these will increase the overall “dead space,” and nurses must flush after administration. One option is Medela’s Dose Cap, which provides an easy option for PO enteral delivery of medication.
Pharmacy has concerns as well, although they differ slightly. These three top concerns are:
- Cost – Pharmacy must switch from bulk, non-sterile supplied PO syringes to ENFit
- Product changes – None of the current adapters used in pharmacy to draw up mediations will work. All must be switched to ENFit adapters
- Technician impact – The twist locking system means that Pharmacy Techs must insert the syringe, twist to lock, draw up the medications, untwist, and twist on a cap. That means almost three twisting motions per medication, which may cause ergonomic issues for the technician
A simple product exists that allows both nursing and pharmacy to avoid the issue of a large tip, cost, product changes, and technician impact. That product is the Medela Dual Cap. The Dual Cap allows for clinicians to control the method of administration – which is much as nurses already do today.
The Dual Cap solution allows Pharmacy to continue purchasing their non-sterile, bulk supplied PO syringes. Pharmacy would draw up medications the same way they are doing today. No new cost, adapters, or twisting motion needed.
Medications would then arrive to the nursing units in the PO syringe, and nursing would control how to administer. If PO, then the syringe can go directly into the infant’s mouth. If NG, the Dual Cap is placed onto the end of the PO syringe, and administered via the NG tube. This is a simple solution for all the issues of the new design when administering low dose medications.
The primary message here is to know how ENFit will impact medication administration in your clinical area, and what solutions are available that will work for your facility.
About the Author
Kathy 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.