Syringes, Extensions, and Other Suppliesadmin2020-03-10T16:26:53+00:00
About half of families in the United States currently are receiving the new ENFit style feeding tubes, extension sets, and syringes, while the remainder are still receiving the old legacy style. Note that legacy products will be phased out beginning July 2020. The ENFit system is designed to make connections between different enteral components safer, and to make sure misconnections with other devices do not occur. We have detailed information about the history and timelines for ENFit on our ENFit Information page.
The following items differ depending on whether you have the newer ENFit style or old, legacy products:
PEG, PEJ, and other long feeding tubes (but NOT low-profile devices with removable extension sets)
Extension sets for low-profile feeding tubes
Feeding bags for feeding pumps
Farrell bags and gastric drainage bags
This page includes information on both old (legacy) and new ENFit versions of syringes, extension sets, and adaptors.
If you have a button style feeding tube, rather than a nasal or long tube, you will need extension sets that attach to the button. These extension sets connect from the button to a syringe or a feeding pump bag to allow you to feed, give medications, and administer liquids.
Anatomy of an Extension Set
An extension set has three main parts:
Connector: this connects the extension set to the feeding bag or syringe. There are two different types, ENFit and Legacy, and each comes in two different styles, Y-port or Bolus.
Tip: this connects the extension set to the button or low profile feeding tube. There are two types: Right Angle or Straight.
Clamp: when closed, this stops fluid from moving through the extension set. When open, fluid flows.
Below are images and information about the new ENFit extension connectors and the older legacy connectors. Both are the Y-port style. Note that AMT also offers a hybrid option extension set, with both ENFit and legacy connectors.
ENFit Style Extension Set
An ENFit style extension set has an end that looks like this image. The extension set has a male ending that will screw into the female end found on products like Feeding Bags, Syringes, and Farrell Bags.
Legacy Older Style Extension Set
The traditional older style extension set will have an end like the one in the image. It connects only by the force of pushing the two ends together.
Tips: Right Angle versus Straight
Extension sets may connect with the button or low-profile feeding tube using two different styles: 90-degree angle or straight.
90 Degree Angle: Connects at a 90 degree angle laying flat against the body; smaller diameter tube; best for continuous feeds and giving medications. It is the “L-shaped” connector on the right of the image.
Straight: Connects straight into the button and sticks straight out; has a larger diameter tubing to accommodate larger volumes and thicker formulas; best for bolus/gravity feeds and venting. It is the straight connector on the left of the image.
*Exact product names will vary by manufacturer.
Each button manufacturer produces extension sets that fit their buttons, and offers multiple styles in terms of length and port options. Know there are many options available, so you can request what will work best for your needs.
Before using the extension set, prime it (fill it) with water or food/formula to get the air out. Priming should always happen prior to connecting the extension set to the button, otherwise the air in the empty extension will be pushed into the stomach. The easiest way to prime the set is to open the straight-port on the top, hold it under a faucet, and run water directly into it. Be sure to close the side medication port first (if one is present), and pinch the clamp closed once there is no more air in the extension set. You can also fill the extension set by using a syringe if the extension set is not connected.
Another option is to connect the extension set to the feeding set and prime the entire length of tubing at one time. After use, extension sets can be cleaned with dish soap and hot water. They should be rinsed well so that no soap remains in the tubing. Extension sets are usually replaced every 1 to 2 weeks, but can be used up to a month, if necessary.
Common Types of Extension Sets
Most individuals with buttons or low-profile feeding tubes have devices made by either AMT or Mic-Key. Each manufacturer has specific extension sets designed to fit their devices; however, there are some that fit both types.
Extension sets clean pretty easily if you use very hot water. You can hold the extension directly under the faucet or use a 60 mL syringe to push hot soapy water through it. After washing, close the clamp and drag it down the extension to “strip” the extension of its residue. You can also use the back of a butter knife, as if you were curling ribbon, to loosen residue. Wash again to rinse any remaining residue out of the extension. Rinsing the extension after every feed seems to extend the life of the extension a little. You can also just store it in the refrigerator between feeds to prevent build-up.
Pipe cleaners can also help to get stuck-on gunk from the ends of an extension, and soaking and filling extensions with Efferdent denture cleaner can help bubble off residue.
Depending on the formula used, some extension sets may only last a week. With proper care, some can be extended to last a full month.
See the videos on this page for a video on cleaning the extension set.
Note that ENFit extension sets may require additional cleaning. The ends can be cleaned with a toothbrush or a specially designed ENFit cleaning tool such as the NeoMed Cleaning Tool or the ENClean Brush.
The new ENFit connectors are designed to screw together to prevent disconnection between the extension set (or long tube) and the feeding bag or syringe. Using these connectors will help reduce disconnections.
At some point you will feed something other than your child; there is just no way around it. The extension will come unhooked from your child or the feeding bag, or the med port will pop open. Keeping everything clean and dry gives you the best chance of avoiding an accident.
Wipe the connector from the food bag before connecting to the extension. If you use the med port to give meds, use a Q-Tip to wipe inside the med port before you close it again.
There are also a lot of products out there to try to hold the med port closed or to keep the extension and food bag connected. There are also extension sets available without a med port. Click here to view Med Port Covers and Clamps.
Children with G-tubes typically only need a small flush, 3-5ml for a 12 inch extension, and 6-10ml for a 24 inch extension. The amount of flush should clear the extension set and button of formula or medication. For children with long tubes, the amount required depends on the length of the tube. Your child’s doctor may request you flush the tube with additional water if the child needs additional fluids or if you have a problem with the tube clogging frequently.
Children with GJ-tubes need a flush that will clear their extension set or tube on the outside plus the J-tube on the inside. Depending on the length of the inner J tube (22cm, 30cm, or 45cm), the size of the flush may vary. In general, a minimum of 10ml is recommended, though less may be used for a shorter inner J tube. For the 45cm length, at least 15mls should be used to ensure that the flush clears the J.
Ideally, you should flush before administering medication, between each medication, and after all medications are administered or the formula has finished. In reality, this may be too much water for many children. You should always flush after a series of medications have been administered, or when the formula is finished.
For children on continuous feeds, it is still wise to flush frequently, at least once every 4-8 hours, to prevent clogging.
There are many different types and sizes of syringes. Many families who use a syringe for feedings or venting prefer larger 60ml syringes. Most medications can be dosed using 1, 5, or 10ml syringes.
Those who have ENFit feeding tubes and extension sets will need to use specially designed ENFit syringes that screw into the connectors. These are available through DMEs, some pharmacies, and can also be purchased online at Health Care Logistics. In addition, NeoMed has a large line of ENFit syringes that are extremely useful.
Those with legacy connectors can use a wide variety of types of syringes, as seen in the image below. Catheter (large, long tip) or slip tip (short, thin tip) syringes are good choices to start.
Syringes may or may not be covered by insurance. Some pharmacies will give syringes out for free with medications. Syringes can be reused at home. They can be washed with soap and hot water and rinsed well. Do not put syringes in the dishwasher.
ENFit Syringes (NeoMed brand)
There are many types of tape with varied uses.
Hypafix: This is a flexible, breathable cloth tape that must be cut with scissors. It has a strong hold even when wet but is gentle on skin. It works well for securing NG-tubes and G-tube/GJ-tube extension sets.
Micropore: Micropore (paper tape) is a gentle adhesive that comes off easily when wet. It is the most versatile kind of tape and it works well for securing G-tube or GJ-tube extension sets to the skin.
Medipore: Medipore is a flexible, breathable cloth tape similar to Hypafix except that it is pre-perforated so no scissors are necessary. The adhesive is not quite as strong as Hypafix.
HY tape: This is a non-breathable waterproof tape that works well for sensitive skin and for taping NG-tubes.
Durapore: Durapore is a silky cloth tape with a very strong adhesive. It is not good for sensitive skin but has a strong hold unless it gets wet. It works well for taping NG-tubes and extension sets to clothing.
Currently, some families are receiving a mixture or ENFit and Legacy devices. Adapters are available to connect between Feeding Sets and tubes or extension sets. AMT has a wide range of Adapters available, and they may be available from other companies as well. There are also other adapters available to add clamps or medports to long feeding tubes or otherwise connect syringes and tubes.
NOTE: Not all specific products will be supplied by every supplier or covered by every insurer. You may be able to get specific products covered or request more of a particular product (such as extension sets) by requesting a letter of medical necessity from your doctor or nurse practitioner.