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Erschienen in: Current Nutrition Reports 3/2016

05.07.2016 | Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)

Universal Small Bore Connectors (ENFit) for Enteral Access: Implications for Clinical Practice

verfasst von: Ryan T. Hurt, Keith R. Miller, Jayshil Patel, Panna Codner, Manpreet S. Mundi

Erschienen in: Current Nutrition Reports | Ausgabe 3/2016

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Abstract

Misconnections with various types of intravenous and enteral access devices have been recognized as a potentially deadly healthcare problem. Contributing factors to these misconnections include lack of healthcare provider education, transporting patients to different locations, and interchangeability of the enteral tubes with other tubes such as central venous catheters. An international effort led by EN industry leaders has developed a small bore enteral connector (ENFit) that, in theory, will reduce the frequency of misconnections. We fully endorse the development of a safer EN access device that will minimize the risk of misconnections. Despite the potential benefit of preventing misconnections, the full impact of the adoption of the ENFit connector on clinical practice remains unknown. The purpose of this review is to examine the impact of the proposed new small bore enteral connector on a number of clinical situations including delivery of blenderized tube feeds, medications, and venting.
Literatur
1.
Zurück zum Zitat Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med [Meta-Analysis Review]. 2001;29(12):2264–70.CrossRef Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med [Meta-Analysis Review]. 2001;29(12):2264–70.CrossRef
2.••
Zurück zum Zitat McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):59–211. The recent guidelines that are the basis for the evidence-based nutrition practice in the USA.CrossRef McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):59–211. The recent guidelines that are the basis for the evidence-based nutrition practice in the USA.CrossRef
3.
Zurück zum Zitat Tubing misconnections—a persistent and potentially deadly occurrence. Joint Commission perspectives Joint Commission on Accreditation of Healthcare Organizations. 2006;26(5):14-5. Tubing misconnections—a persistent and potentially deadly occurrence. Joint Commission perspectives Joint Commission on Accreditation of Healthcare Organizations. 2006;26(5):14-5.
4.•
Zurück zum Zitat Staebler S. Enteral feeding misconnections in the NICU: a continuing patient safety threat. Adv Neonatal Care [Historical Article Review]. 2013;13(6):447–53. The most recent review examining the problem of misconnections with feeding tubes and outlining specific strategies for minimizing risk.CrossRef Staebler S. Enteral feeding misconnections in the NICU: a continuing patient safety threat. Adv Neonatal Care [Historical Article Review]. 2013;13(6):447–53. The most recent review examining the problem of misconnections with feeding tubes and outlining specific strategies for minimizing risk.CrossRef
5.
Zurück zum Zitat Guenter P, Hicks RW, Simmons D. Enteral feeding misconnections: an update. Nutr Clin Pract. 2009;24(3):325–34.CrossRefPubMed Guenter P, Hicks RW, Simmons D. Enteral feeding misconnections: an update. Nutr Clin Pract. 2009;24(3):325–34.CrossRefPubMed
6.
Zurück zum Zitat Beyea SC, Simmons D, Hicks RW. Caution: tubing misconnections can be deadly. AORN J [Research Support, NIH, Extramural]. 2007;85(3):633–5. Beyea SC, Simmons D, Hicks RW. Caution: tubing misconnections can be deadly. AORN J [Research Support, NIH, Extramural]. 2007;85(3):633–5.
7.
Zurück zum Zitat Guenter P, Hicks RW, Simmons D, Crowley J, Joseph S, Croteau R, et al. Enteral feeding misconnections: a consortium position statement. Jt Comm J Qual Patient Saf. 2008;34(5):285–92. 45.PubMed Guenter P, Hicks RW, Simmons D, Crowley J, Joseph S, Croteau R, et al. Enteral feeding misconnections: a consortium position statement. Jt Comm J Qual Patient Saf. 2008;34(5):285–92. 45.PubMed
8.
Zurück zum Zitat Simmons D, Phillips MS, Grissinger M, Becker SC. Error-avoidance recommendations for tubing misconnections when using Luer-tip connectors: a statement by the USP Safe Medication Use Expert Committee. Jt Comm J Qual Patient Saf. 2008;34(5):293–6. 45.PubMed Simmons D, Phillips MS, Grissinger M, Becker SC. Error-avoidance recommendations for tubing misconnections when using Luer-tip connectors: a statement by the USP Safe Medication Use Expert Committee. Jt Comm J Qual Patient Saf. 2008;34(5):293–6. 45.PubMed
9.
Zurück zum Zitat Vockley M. Dangerous connections. Health care community tackles tubing risks, small-bore connector standards. Joint Comm Perspect Joint Comm Accredit Healthcare Org. 2012;32(5):9–10. Vockley M. Dangerous connections. Health care community tackles tubing risks, small-bore connector standards. Joint Comm Perspect Joint Comm Accredit Healthcare Org. 2012;32(5):9–10.
10.••
Zurück zum Zitat Mundi MS, Epp L, Hurt RT. Increased force required with proposed standardized enteral feed connector in blenderized tube feeding. Nutr Clin Pract. 2016. doi:10.1177/0884533616639126. A recent novel study evaluating a prototype of the new small bore connector and the force required to deliver a blenderized diet through a feeding tube. Blenderized diets required more force to be applied to the syringe than the current standard connector to deliver the feedings. Mundi MS, Epp L, Hurt RT. Increased force required with proposed standardized enteral feed connector in blenderized tube feeding. Nutr Clin Pract. 2016. doi:10.​1177/​0884533616639126​. A recent novel study evaluating a prototype of the new small bore connector and the force required to deliver a blenderized diet through a feeding tube. Blenderized diets required more force to be applied to the syringe than the current standard connector to deliver the feedings.
11.••
Zurück zum Zitat Hurt RT, Edakkanambeth Varayil J, Epp LM, Pattinson AK, Lammert LM, Lintz JE, et al. Blenderized tube feeding use in adult home enteral nutrition patients: a cross-sectional study. Nutr Clin Pract. 2015;30(6):824–9. doi:10.1177/0884533615591602. The first study to evaluate the prevalence of blenderized diet use since the movement to a closed nutrition system. In this single centered study of home enteral nutrition patients, 55.5% reported using blendered diets as at least part of their weekly tube feedings. Hurt RT, Edakkanambeth Varayil J, Epp LM, Pattinson AK, Lammert LM, Lintz JE, et al. Blenderized tube feeding use in adult home enteral nutrition patients: a cross-sectional study. Nutr Clin Pract. 2015;30(6):824–9. doi:10.​1177/​0884533615591602​. The first study to evaluate the prevalence of blenderized diet use since the movement to a closed nutrition system. In this single centered study of home enteral nutrition patients, 55.5% reported using blendered diets as at least part of their weekly tube feedings.
12.
Zurück zum Zitat Simmons D, Symes L, Guenter P, Graves K. Tubing misconnections: normalization of deviance. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition [Review]. 2011;26(3):286–93.CrossRef Simmons D, Symes L, Guenter P, Graves K. Tubing misconnections: normalization of deviance. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition [Review]. 2011;26(3):286–93.CrossRef
13.
Zurück zum Zitat Wallace JR, Payne RW, Mack AJ. Inadvertent intravenous infusion of milk. Lancet. 1972;1(7763):1264–6.CrossRefPubMed Wallace JR, Payne RW, Mack AJ. Inadvertent intravenous infusion of milk. Lancet. 1972;1(7763):1264–6.CrossRefPubMed
14.
Zurück zum Zitat FDA updates tubing misconnections website. Health Devices. 2012;41(10):334. FDA updates tubing misconnections website. Health Devices. 2012;41(10):334.
15.
Zurück zum Zitat Tubing misconnections—a persistent and potentially deadly occurrence. Jt Comm J Qual Patient Saf. 2006;32(7):411-3. Tubing misconnections—a persistent and potentially deadly occurrence. Jt Comm J Qual Patient Saf. 2006;32(7):411-3.
16.
Zurück zum Zitat Hurt RT, McClave SA. Gastric residual volumes in critical illness: what do they really mean? Crit Care Clin. 2010;26(3):481–90. viii-ix.CrossRefPubMed Hurt RT, McClave SA. Gastric residual volumes in critical illness: what do they really mean? Crit Care Clin. 2010;26(3):481–90. viii-ix.CrossRefPubMed
17.
Zurück zum Zitat Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA [Multicenter Study Randomized Controlled Trial Research Support, Non-US Gov’t]. 2013;309(3):249–56. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA [Multicenter Study Randomized Controlled Trial Research Support, Non-US Gov’t]. 2013;309(3):249–56.
18.
Zurück zum Zitat Powell KS, Marcuard SP, Farrior ES, Gallagher ML. Aspirating gastric residuals causes occlusion of small-bore feeding tubes. JPEN J Parenter Enteral Nutr. 1993;17(3):243–6.CrossRefPubMed Powell KS, Marcuard SP, Farrior ES, Gallagher ML. Aspirating gastric residuals causes occlusion of small-bore feeding tubes. JPEN J Parenter Enteral Nutr. 1993;17(3):243–6.CrossRefPubMed
Metadaten
Titel
Universal Small Bore Connectors (ENFit) for Enteral Access: Implications for Clinical Practice
verfasst von
Ryan T. Hurt
Keith R. Miller
Jayshil Patel
Panna Codner
Manpreet S. Mundi
Publikationsdatum
05.07.2016
Verlag
Springer US
Erschienen in
Current Nutrition Reports / Ausgabe 3/2016
Elektronische ISSN: 2161-3311
DOI
https://doi.org/10.1007/s13668-016-0173-7

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