Nasogastric and enteral tubes

Norms for enteral devices

  • EN 1615: 2001: Enteral feeding catheters and enteral giving sets for single use and their connectors, edition: 2
  • ISO 80369-1: 2010: Small-bore connectors for liquids and gases in healthcare applications -- Part 1: General requirements
  • ISO 80369-3: 2016 ​(A 1:2019): Small-bore connectors for liquids and gases in healthcare applications -- Part 3: Connectors for enteral applications
  • ISO 80369-20: 2015: Small-bore connectors for liquids and gases in healthcare applications - Part 20: Common test methods

ISO 80369 standards were created to reduce the frequency of misconnections and at the same time harmonize delivery systems across one therapeutic area.

ENFit

There were numerous reports detailing the risks of compatible tubing systems and the risk to patients. Cases of misconnections are under-reported and many may show as medication errors. Several people did die from misconnections and many more were put at serious risk.

The ISO 80369 series of standards were designed to prevent misconnections of medical devices and ensure patient safety. ISO 80369-3 specifically addresses enteral and gastric medical device applications by defining the geometry, material characteristics and performance of a new standard connector pair.

ENFit is a global change to make all enteral (tube feeding) devices specific to tube feeding. Every administration set, enteral syringe, nasoenteral tube, and nasogastric tube will be designed with a specific ENFit end so that you can only use products designed for enteral/tube feeding access.

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Preventing misconnection errors

  • Regularly inspect tubing for proper connections.
  • Use the correct fittings and connect them according to the manufacturer's instructions.
  • Reconnect tubing only under good lighting. Trace tubing back to the source prior to reconnecting.
  • Do not modify or try to adapt connections to enteral devices.
  • Do not use IV pumps to administer enteral feedings.
  • Use enteral syringes (that cannot connect with an IV line) to deliver medications enterally.

Confirm the correct position of nasogastric tubes

using pH test strip (ELABPAPEPH2G)

Check the tube position:

  • Following initial insertion
  • Before any liquid (feed or medication) is introduced into the tube. At the change of feed if the child is receiving continuous tube feeding (four-hourly for expressed breast milk and six-hourly for all other feeds)
  • Following episodes of vomiting, retching or coughing
  • Following evidence of tube displacement (e.g. when the visible tube length has increased)

Recommended procedure:

  • Check whether the patient is on medication that may increase the pH level of gastric contents (antacids, H2 antagonists)
  • Obtain sufficient aspirate (0.5 – 1 ml) to cover an adequate area on the pH test strip
  • Aspirate is pH 5.5 or below: OK
  • Aspirate is pH 6 or above: DO NOT FEED: leave up to one hour and try again: possible bronchial secretion or dilution of the gastric acid by enteral feed.

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