Background The ISO 80369–3 standard makes it possible to secure the enteral nutrition connectors by introducing the ENFit system, which differs from the old connector technology in that it has a thinner internal diameter.
Purpose The aim of this study was to determine the impact of this change of connectivity on the administration of enteral medication.
Material and methods The first part of the study consisted of an evaluation of the professional practices (EPP) of the nurses on the enteral administration by a questionnaire.
The second part was an in-vitro study comparing several methods of administration via ENfit tubing. Morphine sulphate extended release (ER) placebo micro-granules were used as a model. An amount of microgranules corresponding to the lowest commercially available ER morphine sulphate assay was weighed and enumerated to extrapolate at the highest dosage, which will be used as a reference throughout the study. A quantity of micro-granule was weighed, suspended in water and administered at the site of the ENFit tubing. Subsequently the tubing was rinsed with water. The number of micro-granules at the inlet and outlet of the tubing were compared to determine the percentage of micro-granules administered.
Results Ninety-five nurses from 10 care units participated in the EPP. The simultaneous grinding of several drugs was a common practice (88%). The correct methods of rinsing of the ENFit tubing and dissolving of medications were applied by only 20% of nurses.
The in-vitro study has shown that the change of connectors prevents the direct introduction of micro-granules at the site of administration. The first method of administration, which consisted of suspending micro-granules in a cup, resulted in a 10% loss. The second, which consisted of putting the micro-granules in a syringe and then taking the water, resulted in a 3% loss. The third was the most suitable method, because it did not cause any loss, consisting in suspending the micro-granules in a syringe filled with water.
Conclusion The ENFit system complicates the enteral administration of drugs in the form of micro-granules. Corrective actions are needed to optimize administrative practices, including support for nurses and the development of medical devices that would limit misuse.
References and/or acknowledgements Thanks to the nurses.
No conflict of interest.