Enteral Nutrition Connectors and Misconnections

New Enteral Connectors

In 2015 new patient end enteral connectors will be coming into the market, first on administration sets, then on syringes and then on feeding tubes. ASPEN is partnering with the Global Enteral Device Supply Association (GEDSA) and other organizations such as The Institute for Safe Medication Practices, The Joint Commission, Association for the Advancement of Medical Instrumentation, and others to provide awareness, to prepare for these changes, and to educate all stakeholders. For communication on this, visit StayConnected2015.org.
 
August 20, 2014, the Joint Commission issued a Sentinel Event Alert and Infographic to raise awareness about the new EN connectors. Share this Joint Commission Sentinel Event Alert with your colleagues. 
 
 
Checklists to Prepare for New EN Connectors 
Nursing Protocol Update by ASPEN on December 18, 2014
Webinar held December 3, 2014 by the Joint Commission - Access Here

Definition

An enteral misconnection as defined by the ASPEN. Board of Directors and Clinical Practice Committee as “An inadvertent connection between an enteral feeding system and a non-enteral system such as an intravascular line, peritoneal dialysis catheter, tracheostomy, medical gas tubing, etc.” Guenter P, Hicks RW, Simmons D, et al. Enteral feeding misconnections: a consortium position statement. Jt Comm J Qual Patient Saf. 2008;34(5):285-292.

ENFit® Syringe Medication Delivery Procedures

The ASPEN Board of Directors approved the following ENFit® Syringe Medication Delivery Procedures for both inpatient settings and home settings. These procedures should help the staff and patient/caregivers transition to the new ENFit syringes.

Inpatient Procedure
Home Care Procedure

Enteral Nutrition Misconnections Literature 

Guenter P. New Enteral Connectors Raising Awareness. Nutr Clin Pract, 2014

Debora Simmons, Lene Symes, Peggi Guenter, and Krisanne Graves. Tubing Misconnections: Normalization of Deviance.  Nutr Clin Pract, June 2011; vol. 26, 3: pp. 286-293   

Guenter, P, Hicks RW, Simmons D.  Enteral Feeding Misconnections: An UpdateNutr Clin Pract. 2009;24:325-334.

Sarah J. Miller. Enteral Feeding Misconnections: A Consortium Position Statement.  Nutr Clin Pract. Dec. 2008-Jan. 2009; vol. 23, 6: pp. 664-665

Guenter P, Hicks RW, Simmons D, et al. Enteral feeding misconnections: a consortium position statement. Jt Comm J Qual Patient Saf. 2008;34(5):285-292

Lindsey Getz. Enteral Misconnections — Changes in Pipeline to Prevent Deadly Errors.
Today’s Dietitian. Feb 2010; 12 (2): 18.

Enteral Misconnections: Government Agencies’ Resources

Food and Drug Administration (FDA)

Updated Tubing Misconnection

  •  Enteral Feeding Tube Manufacturers
  • Healthcare Professionals
  • Hospital Purchasing Departments

FDA Medical Device Safety Calendar 2009 

Patient injuries and deaths have occurred when different device delivery systems are mistakenly connected to each other. These errors are often facilitated by fittings called Luer connectors, which can allow different systems to be easily, but erroneously, connected. 

The 2009 Medical Device Safety Calendar (Luer Misconnections) is one of FDAs efforts to help educate healthcare professionals about these dangerous misconnections. The calendar provides a graphic depiction of a variety of misconnection cases, coupled     with recommendations from The Joint Commission on ways to prevent these types of errors. On this website, you can download or print the calendarcase studies, and additional resources about Luer misconnections and how to help prevent them. Clinical     facilities may request copies of calendar, free of charge, at [email protected] while supplies last.

Reduce - and Report - Enteral Feeding Tube Misconnections.  Article by Courtney Jennings Millin, PhD, and Mary Brooks, MS, BSN, RN. Reprinted from Nursing2010, November issue, p.60.

 Enteral Misconnections: Other Organizations’ Resources

Association for the Advancement of Medical Instrumentation (AAMI)
The Association for the Advancement of Medical Instrumentation's (AAMI's) mission is to provide global multidisciplinary leadership and programs that enhance the goals and capabilities of the professions, healthcare institutions, government, industry and other institutions that relate to the delivery, development, management, use and other aspects of safe and effective medical instrumentation and related technologies. 


International Enteral Connector Standard Approved
The Draft International ISO Standard Small-bore connectors for liquids and gases in healthcare applications - Part 3: Connectors for enteral applications has been approved as a provisional standard and is available in the US as AAMI/CN3(PS):2014 through AAMI. This standard specifies the dimensions and requirements for the design and functional performance of small-bore connectors intended to be used on enteral medical devices and accessories. This is a provisional standard but it being published because it is urgently needed in the United States to promote patient safety. Once the final version of ISO 80369-3 is approved by ISO, this provisional standard will be replaced by a parallel adoption of ISO 80369-3. For more information on the transition to the new connectors and other resources, please go to the A.S.P.E.N. Enteral Connectors Toolkit.

Dangerous Connections… Healthcare Community Tackles Tubing Risks (PDF). Biomedical Instrumentation & Technology. Nov/Dec 2011

FDA Issues Feeding Tube Misconnection Guidance Document (Posted July 30, 2012) Accessed 1 August 2012

New Standard Aims to Reduce Device Misconnections (January 4, 2011) Accessed 4 August 2012

BI&T Covers Medical Tubing Misconnections (November 22, 2011) Accessed 4 August 2012

Mother's Death Spurs Nurse to Highlight Tubing Dangers AAMI News: August 2012, Vol. 47, No. 8 Accessed 4 August 2012

Multiple IV Infusions Safety  (May 2012 Webinar PowerPoint slides pdf) Accessed 4 August 2012

Infusing Patients Safely: Priority Issues from the AAMI/FDA Infusion Device Summit (October 2010) Accessed 4 August 2012. 

American Society of Health-System Pharmacists (ASHP)

Online CE Program

Improving I.V. Medication Safety in the Intensive, Critical, and Coronary Care Units: Role of the Interprofessional Team

ECRI Institute (ECRI)

ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care

Top 10 Health Technology Hazards for 2012 (enteral feeding misconnections rank 6th)

Health Devices: Preventing Misconnections of Lines and Cables. March 2006, Volume 35, Number 3 

PENNSYLVANIA PATIENT SAFETY ADVISORY Vol. 7, No. 2 June 2010 Contains a section on enteral misconnections case reports and risk reduction strategies. 

Institute for Safe Medication Practices (ISMP)

ISMP advocates the use of non-Luer connectors and safety practices when using enteral feeding tubes.

Preventing errors when administering drugs via an enteral feeding tube

Preventing catheter/tubing misconnections: Much needed help is on the way  

Purple is not an official standard for either enteral feeding equipment or PICC lines June 4, 2009.

Improvised drug delivery: A cause for concern April 22, 2004. 

Related Publications and Tools