Time to Reassess: Small Bore Connectors

The worldwide process to design and produce new, safer, small bore connectors is nearing its conclusion. Background information on the need for redesign and the process involved is at

For California hospitals and skilled nursing facilities, state law set deadlines of July 1, 2016 and January 1, 2017 for the adoption of new connectors for enteral and epidural applications, respectively. But there was not an adequate supply in the U.S. market for safe adoption of the new enteral (ENFit) connectors by the July 1 deadline, and there was concern that a similar problem would occur for epidural applications.

Enteral connectors (ENFit)

Within the past few weeks, some hospitals have identified sufficient supply of enteral connectors and have begun an orderly process of changing over. We suggest that all hospitals now review with their suppliers their particular needs for enteral products and proceed in switching over when they have identified sufficient and reliable supply to do so.

Switching over connectors takes planning and time to do safely. The StayConnected website ENFit section has materials produced by manufacturers, GPOs, patient safety organizations, and others who assist in the process. In particular, we recommend the “Take Action” tab on the ENFit page. Assistance may also be available from your suppliers and the manufacturers of the products you use. You may also contact CHPSO for further information.

Recognize that some patients will need to use the old conical connector—particularly tube feeders using home-blenderized diets, as the inner bore of the ENFit connector is smaller than previous connectors.

Neuraxial connectors (NRFit)

In latest discussions with manufacturers, CHPSO has learned that supply of most NRFit devices should enter the USA market in January 2017. However, infusion pump cassettes from certain manufacturers will not be available until February or March, and for one manufacturer we do not know when the cassettes will be available.

Since continuous epidural anesthesia generally uses an infusion pump, the limiting factor for adoption of NRFit in a hospital may be the cassettes for the particular pump used at that hospital. Now is the time to start planning for the transition to the new NRFit connector, so that when supply is available your hospital will be ready.

Unlike enteral applications that typically used enteral supplies, current neuraxial applications often use “intravenous” supplies, so identification of the new supplies needed will have to include explicit identification of the intravenous supply use driven by neuraxial applications.