Transition Adapters for ENFit Syringes Can Defeat the Purpose of ENFit Itself

Some hospitals have finally begun converting to ENFit tubing, syringes, and administration sets for enteral feedings and medications to prevent misconnections with vascular access sites. But, in case hospitals and/or patients are not yet using ENFit feeding tubes, manufacturers are still distributing ENFit administration sets with transition adapters (Figure 1). These transition adapters can be removed to expose an ENFit connector for patients who have an ENFit feeding tube, or can remain in place if the patient has a legacy feeding tube with a Luer connector. This temporary measure is necessary to assure compatibility with either system. The transition adapters will eventually be eliminated when all are using feeding tubes with an ENFit connector.

In addition to the above, we’ve recently learned that other types of adapters have now become available to facilitate a connection between legacy oral syringes and the new ENFit connectors on feeding tubes. Alarmingly, some of these adapters even fit parenteral syringes that have a Luer-slip or Luer-lock tip (Figure 2).

ISMP has long advocated prohibiting preparation of any oral liquid medication in a parenteral syringe. If this unsafe practice occurs, these add-on adapters would need to be applied after the dose has been prepared in the parenteral syringe. If this step is omitted, and the adapter is not applied to the parenteral syringe, the oral liquid would be in a syringe that could be connected to an intravenous (IV) port, allowing for the possibility of administration by the IV route.

In addition to the risk of inadvertent IV injection of oral liquids or suspensions when using these adapters with a parenteral syringe, the adapters may also be a choking hazard if left at the bedside, similar to caps from syringes that have been left at the bedside or lost in the bed sheets during administration.

Furthermore, these add-on adapters can undermine the low dose ENFit syringe tip (on ENFit syringes of 5 mL or less) that was specially designed to minimize the dead space and associated volume retention during drug administration. The add-on devices appear to have significant dead space that will allow the accumulation of fluid during administration, which will never reach the patient. Thus, these adapters can cause inaccurate liquid dosing of small volume liquids in neonates and pediatric patients, and in adults who are receiving drugs that have a narrow therapeutic index. For more information about the low dose tip, please click here. 

ISMP stands behind the need for full conversion to ENFit devices to reduce the risk of accidental connection of syringes and administration sets meant for other routes of administration. Transition adapters for feeding tubes must be considered a temporary measure only. Adapters for syringes add risk, especially when the adapter allows compatibility between Luer-tip syringes that should never be used for preparing or administering oral liquids or suspensions. As soon as possible, full conversion should occur to feeding tubes and administration sets that use only integrated ENFit connectors. In the meantime, all risks, even if temporary, should be fully explained and outlined to staff.