A Victory for NICU Patient Safety

Hospital NICUs are getting an early Christmas present: the ability to opt out on tubing that could put their newborn patients at risk.

The Joint Commission, the nation’s foremost accreditation organization for health care programs, recently confirmed it will not endorse tubing connector technology known as ENFit.  Hailed as a victory for infant safety, the decision comes in response to a letter from the National Coalition for Infant Health that outlined concerns about the ENFit design.

But, what is the ENFit tubing connector? And, why is this a victory for infant safety?



For NICU patients, tubes administer vital fluids like nutrition, blood and medicine. Tubes used to be compatible regardless of which fluid they transported. But when tubing mix-ups began causing medical complications, even patient deaths, manufacturers started developing proprietary tubing connectors specific to their own devices.  One such device was ENFit.

The ENFit design does stop tubing misconnections, which could otherwise cause medication, nutrition or other fluids to be delivered to the wrong place in a patient’s body.  But ENFit introduced unintended problems related to medication dosing.

The moat, or area around the syringe barrel, is difficult to clear. Medication can “hide” there, inadvertently increasing the dosage delivered when the syringe is inserted into the feeding tube. If the moat is not cleared, a premature infant may receive up to 30 percent more medication per dose. This places the baby at risk for an overdose and adverse drug reactions.

This moat design also increases the risk for infection if residual breast milk or formula remains in the moat and is then connected to the feeding tube. The potential for bacterial colonization of the moat (given that feeding tubes in NICU patients are in place for up to 10 days at a time) increases exponentially with the ENFit design.

The Joint Commission reiterated in its letter that it does not mandate the use of any technology, nor does it endorse specific manufacturers, products, or devices.  The clarification reinforces hospitals and clinicians’ ability to determine which products are best for their patients. It also allows health care providers to continue protecting vulnerable infants from inaccurate dosing of medications at small volumes.

To learn more about the dangers of tubing misconnections, read neonatal nurse practitioner Suzanne Stabeler’s guest post, “Tubing Mix-Ups Pose New Dangers for Infants.”


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