What is ENFit?
Example of an ENFit extension set with locking ports
ENFit is a global change to make all enteral (tube feeding) devices specific to tube feeding. Every extension set, syringe, long tube/PEG, and NG-tube will be designed with a specific ENFit end so that you can only use products designed for enteral/tube feeding access. Button style G-tubes will not change at all — only the extension sets that connect to them.
Why is this happening?
Way back in 2006, many in the enteral community expressed concern about the ability of medical devices to connect across systems. So, for example, syringes used for tube feeding would also fit into IV systems of TPN patients. There were numerous journal articles detailing the risks of compatible systems and the risk to patients. Here is one from 2008. Cases of misconnections are under-reported and many may show as medication errors. Several people did die from misconnections and many more were put at serious risk. In our pediatric community, there is also a very serious risk of disconnection. Current systems, particularly med ports, open easily, making it possible for our children to miss feeds for hours, particularly overnight. This is an inconvenience for most, but a serious problem for children who have issues maintaining their blood sugars.
It took several years to get all manufacturers of enteral products around the world together to move to a standard connection. A trade group was formed called GEDSA to work through the transition. You can read more about it at the Stay Connected Website and sign up for updates. The roll out is worldwide with staggered timing. There is a lengthy transition period during which both the old and the new enteral products will be available. You can read our earlier updates from January 2015 and February 2015 for more information.
What’s Feeding Tube Awareness Foundation’s role in this?
We support the changes because they mean greater patient safety. Moreover, they mean the possibility of fewer disconnections from feeds. For the last few years, we have worked with GEDSA by providing feedback from the pediatric tube feeding community. We also try to help parents navigate the change by providing information and education. We also use these products to feed our children, so we understand how challenging it can be to have them change. Feeding Tube Awareness Foundation does not have anything to do with the design of ENFit, specific product designs, or distribution of ENFit products.
Where are we now?
ENFit versions are available for all product lines in the United States. However, some durable medical equipment providers have not transitioned over. We estimate about 2/3 of families are receiving ENFit versions and 1/3 are receiving the older versions as of 2020.
A few helpful tips:
- AMT has released a series of adapters so that you can continue to use your current supplies and stockpiles.
- It will take time for supply companies to work through their stock of supplies with the old connectors before they start mass distribution of the new ENFit supplies.
- Low-dose ENFit syringes have been redesigned to prevent the medication errors that were a concern with preliminary designs. There are also adapter caps to ensure accurate dosing.
- There is ongoing testing on various commercial formulas and blenderized food products to ensure that tube feeders’ dietary choices will not be impacted by the move to ENFit.
- Multiple companies have created special cleaning brushes to allow for thorough cleaning of all ENFit connectors.