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**I am not a medical professional and the information on this blog is not to be construed as medical advice of any kind. ALWAYS consult with your child's doctor before making any kind of changes to his/her treatment, feeding schedule, etc.**

Wednesday, October 12, 2016

ENFit is here!

After years of waiting, stressing, and anticipating, ENFit is FINALLY rolling out! Yes, I used an exclamation point, and yes I meant it in a happy way. I can't be the only one that's tired of adapters, right?? I first heard of ENFit in early 2013 and at that point, it was supposed to roll out in 2014. Here we are in the 4th quarter of 2016 and we are FINALLY getting ENFit supplies for both ends of the connection, and all I have to say is it's about time!

A lot of people are still unsure of what ENFit is and why the change is happening. For more about that, you can read here, here, and here. The condensed version is that there have been serious injuries and deaths due to medical misconnections, so all medical device connections are changing in phases to be incompatible with each other. ENFit is the name of the enteral (feeding tube) connection. The process started 10 years ago, and although this {ridiculously long} transition phase is a pain in the rear, the end goal is safer connections for everyone.

After many, many delays, ENFit extension sets are now making their way through the supply chain, as are the updated Moog EnteraLite Infinity pump bags. The pump bags had been released in 2014 but there were some issues with the purple ENFit connector cracking, so Moog temporarily went back to the red Christmas tree connectors while they reworked their ENFit connectors to address the problems. Now they're back, and with a slightly different design and (hopefully) improved material that will not crack.

So far, extensions from Halyard and AMT are the only ones I have personally tried out. I had the opportunity to try Halyard's ENFit extension sets back in May. While I do still worry a little bit about the second port being able to pop open and I think I'd feel more comfortable with a cap that twists on, I really liked the ENFit-to-ENFit connection. We used the same extension for 10 days and did not have any med port accidents, accidental dislodgements of any kind, no disconnections between the pump bag and the extension, and really no problems at all with it. Being realistic, it takes more than 10 days to have problems come up, but I felt pretty optimistic about ENFit connections between feeding pumps and extensions after testing out the MicKey ENFit extension. Here's a picture of the ENFit end:

We were surprised (mostly in a good way) to have these new AMT hybrid ENFit extensions show up in our supply delivery this month, along with the new ENFit Moog Infinity bags. They are a hybrid extension, meaning they have an ENFit port and a non-ENFit port. There has been some confusion as people have started receiving these extensions. The white piece where the med port used to be is attached and is not removable. That part is the ENFit port.
I saw these hybrid extensions at a conference I attended in May and was a little confused as to why they would make the med port ENFit rather than the feed port since ENFit pump bags were available already but syringes were not, so I asked their reps. I don't remember the exact details but it has to do with regulations that went into place in July. The manufacturer wanted to provide people with a combination extension but in order to be in compliance with regulations, this was the way they had to do it.

Here is how the hybrid extension works with ENFit Moog pump bags (and Kangaroo Joey pump bags also, I just don't have one of those):
We (Feeding Tube Awareness) still recommend tightening the connection to fingertip tight and not twisting harder than that to avoid damaging either part of the connection, but I noticed that the design changes Moog made to the purple connector makes it so you can only twist it so far. Their previous design made it really easy to overtighten and crack the connector, but this one doesn't seem to work that way.

Syringes and Adapters
AMT has put a lot of effort into helping consumers through the ENFit transition. They have a whole line of adapters available to help us all use the supplies we have stockpiled, and to be able to use our current supplies with the new supplies we are receiving from our supply companies while the transition rolls out. {and no, they're not paying me to say that, I just genuinely appreciate the efforts that AMT makes as a company to serve the needs of consumers}

Since ENFit syringes are not yet being distributed en masse, AMT is including a slip tip syringe adapter with the hybrid extension sets. This is what it looks like:

To use the adapter, you twist the adapter into the ENFit port on the extension until it is "fingertip tight" and then give meds as usual. Simple enough, right?

If the slip tip syringe you're using fits into the syringe adapter, then yes, it is that simple. 

Buuuuut some of our slip tip syringes don't fit. Like that little brown 1 ml syringe on the right. It is the exact same diameter as the adapter and it does not fit. Nor do these 10 ml oral syringes that our pharmacy gives us, which I use for water flushes after meds sometimes. 

So what's a girl to do when the syringes don't fit the adapters?? Or if the adapters crack, which we have been hearing reports of on Feeding Tube Awareness. (If you have an adapter crack, please contact AMT's customer service department and let them know. They are very responsive to consumer feedback and they are aware of this problem and want to fix it!)

Our solution is to just not use the adapter. It so happens that 1 ml, 3 ml, and oral tip syringes fit directly into the feed port, as do cath tip syringes. We've actually been giving all our meds this way for a couple years now because we were tired of dealing with med ports.

I didn't realize the oral tip syringes fit directly into the feed ports until we were inpatient once and I saw a nurse give one of the meds that way. The tip of an oral syringe is longer than the tip of a slip tip syringe, so it actually does fit snugly into the feed port.

I know my opinion will not be popular with some but I really am happy to have ENFit extension sets and pump bags so we don't have to use adapters for that connection anymore. Since we're using the feed port to do meds anyway and now we're using the med port to feed through, giving meds is quick & easy.
For doses that are 1 ml or less, we use 1 ml syringe. For doses from 1-3 ml, we use a 3 ml syringe, and anything more than 3 ml, we use a 10 ml oral tip syringe. We also give things that have to be mixed with water, like powdered PPI packets and probiotic powder, so we use a regular cath tip syringe for those. This may not work for everyone but it has made giving meds much easier for us while we wait for ENFit syringes to reach the supply chain, and hopefully it will help someone else too!

(**Note** I don't have any information about the timeline for ENFit syringes, or how they will be distributed but if and when I hear more, I will share that information as well.)
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