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Hospitals advised to abandon their tubing system may have been misled – news that could come as a relief to parents and health care providers of premature infants.

The trade organization for manufacturers of tubing systems used to deliver nutrition, medicine or fluids to patients recently informed hospitals that their existing devices would be “phase[d] out” starting July 1, 2020.  The organization’s statement explained that the phase-out would make way for a new series of tubing connectors known as ENFit.  The change in technology, the trade organization noted, was meant to “comply” with regulatory guidance and to increase patient safety.

Patient safety is a critical concern.  New connectors were designed to reduce dangerous tubing mix-ups, where connectors for enteral nutrition or medicine get swapped, sending the wrong substance to the wrong part of the body.  But attempted solutions can actually produce new risks for premature infants.  

Before hospitals overhaul their tubing technology, several points are worth considering.

1. ENFit isn’t for everyone.  As pointed out by the National Coalition for Infant Health, ENFit can present some serious issues for premature infants.  Medication can linger in the area around the syringe barrel, inadvertently increasing the medication dose. If the moat is not fully cleared when the syringe is inserted into the feeding tube, a premature infant may receive up to 30 percent more medicine than intended. 

This places the baby at risk for an overdose and adverse drug reactions.  The design also increases the risk for infection if residual breast milk or formula remains in the moat and the connector is then attached to the feeding tube. 

2. Safe, FDA-compliant options still exist.  Not all legacy tubing systems are phasing out.  For instance, manufacturer Vygon issued a statement explaining that it was neither discontinuing nor “ramp[ing] down” production of its tubing system.  Becton Dickinson, another manufacturer of tubing connectors, continues to produce its products as well, while NeoChild and York’s Medical Solutions also both have systems that are compliant with international standards.

The Global Enteral Device Supplier Association may want hospitals and health care providers to plan for a “full conversion to ENFit connectors,” but hospitals and health care providers who have concerns about ENFit shouldn’t be alarmed.

Other safe, FDA-approved options continue to be available.  Each hospital should weigh carefully the risks and benefits of a tubing systems before determining whether a transition is right for its patients.

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