Starting with ENFit: What to Consider

Kathy Quellen, RN, BSN / February 2017


If 2016 was not a year for your facility to look at new safety changes surrounding enteral products, such as ENFit connectors, this would be a great time to start.

If you have been looking at these changes, this is the year you can really move forward. Many kinks have been worked out from a design and regulatory standpoint that will satisfy initial questions surrounding ENFit.

This is also a perfect time to start a project that will not be that difficult to implement, but will bring much needed safety surrounding enteral products and misconnections in the NICU.

Just a quick reminder: ENFit is a design by which enteral products will have their connections switched – male ends will be female, and female will be male. This design was created in order to prevent different application products from connecting to each other.

Everyone has heard the dreaded and disastrous stories of a feeding tube accidently connected to an IV line. No clinician would ever want to be involved in such an incident. The ENFit design was created to prevent such an incident, and is in fact a much-applauded change.

How to start with ENFit

It’s important to look at ENFit products that cater to the NICU or Pediatric patient. Most manufacturers have had ENFit now for over a year and will be ready to accommodate this change, but other unique products are available from some vendors that are only for use in the NICU and Pediatric patients.

Using a NICU-specific enteral vendor for your NICU enteral needs such as ENFit can offer products specifically designed for the NICU such as:

  • A gravity feeding syringe for more efficient gravity feeding or venting.
  • Milk warming solutions, including an inline enteral feeding warmer (that works much like a blood warmer) that warms enteral pump feeds.
  • An enteral-only syringe pump designed for enteral-only use in the NICU that follows regulating agency guidelines. Make sure these devices are wireless-ready as many recommendations for wireless are coming for enteral pumps.
  • Many companies are in the process of designing and approving larger syringes such as 100 mL to 140 mL for use with larger feedings. These can potentially avoid the use of bags on enteral pumps that may waste milk when in use.

I believe once you have looked closely at some of the products on the market, it will become obvious as to why a NICU/Pediatric focused company will be a better fit for you.

These companies will also offer products to assist your ENFit transition impact with your facility’s pharmacy department.

Next ENFit steps

Once you have completed an initial assessment of products, be sure to have a trial and get a good feel for how the products work when in use. You’ll want a vendor that not only has knowledgeable and experienced sales representatives, but also offers a support team of NICU and Pediatric nurses to assist in setting up, educating, and troubleshooting during the trial.

A trial is usually performed with five select patients, not the entire unit. This offers a level of control while minimizing clinician and patient disruption. Limiting patients is especially helpful if you are engaging in multiple trials from different vendors.

It is important in your decision process to verify access to educators to demonstrate the product line to everyone in your NICU. That allows nurses not directly involved with the trial to have the opportunity to be involved in the decision-making process.

When you choose your final vendor, verify that you will get the same education team of representatives and NICU/Pediatric educators that will follow the education process from the trial for a seamless transition.

Bringing ENFit into your NICU or Pediatric unit in 2017 enables you to take safety initiative action. It will take some effort to investigate, evaluate, and implement, but it’s not a major change or project like bringing in very involved technology-based medical devices. Enteral products are part of the “nuts and bolts” of a clinical unit. A safety change here can have a huge impact. It is well worth making ENFit your resolution this year.


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 since 2014. She covers hospitals all throughout the western United States.