New campaign targets neonatal safety

May 21, 2007

The use of intravenous (IV) syringes for non-IV applications such as enteral feedings poses many risks, especially for the pediatric and neonatal population which has a majority of their oral and enteral doses provided through a gastric tube.

The use of intravenous (IV) syringes for non-IV applications such as enteral feedings poses many risks, especially for the pediatric and neonatal population, which has a majority of its oral and enteral doses provided through a gastric tube. Baxa Corp. recently announced the launch of a new educational campaign to make healthcare providers aware of these problems and to offer solutions. The campaign includes promoting the use of dedicated systems for enteral feedings and highlighting the risks to neonates when syringes, administration sets, and other disposables with luer fittings are used for enteral feedings.

Historically, gastric tubes used for neonatal and pediatric enteral nutrition and oral liquid medication administration have incorporated luer fittings to allow the use of hypodermic syringes to access the tube. Standard enteral and intravenous systems are similar in design and contain components that are compatible and fail to restrict the use of one system with another. This can lead to the accidental administration of enteral feeding into the bloodstream or intravenous medication to the digestive system.

"This is a big process change. At our institution we use the Baxa oral syringes for enteral feedings. Currently, all hospitals belonging to C-Wish (Counsel of Women's and Infants' Specialty Hospitals) are in the process of switching over to oral syringes for enteral feeding administration. Some use the Baxa syringes and others the NeoDevice," added Bonny Laub, R.N., NICU clinical educator at Saint Peter's.

There are no published standards that specifically restrict the use of luer connections with certain medical devices. But in the Sentinel Event Alert, The Joint Commission stressed that standard luer syringes should never be used for oral medications and enteral feedings. According to Katie Calabrese, neonatal nurse practitioner and Baxa product manager, "In addition to JCAHO, the UK National Health Service and the [U.S.] Institute for Safe Medication Practices, among other recognized authorities, recommend the use of specialty dispensers for all oral liquid doses."

As part of its campaign, Baxa Corp. has developed a unique system specifically for enteral feedings. The Baxa Exacta-Med Enteral Dispenser is claimed to be the first dispenser designed only for enteral feedings. The Baxa syringe works with the VIASYS MedSystems CORFLO Anti-IV Enteral Feeding System to form a dedicated system that prevents wrong-route administration of non-IV fluid errors highlighted in the alert. The CORFLO system features all non-luer connections and is designed to accept only a dedicated enteral syringe. The Baxa Enteral Syringes have clear barrels with Enteral Orange printing to provide visualization of fluid contents and volume; self-righting Tip Caps to simplify preparation and storage; and non-luer tips to eliminate the chance that a feeding could be infused into the IV line. They are available in 20-, 35-, and 60-mL individual packs.

"Three months ago we switched over to the Baxa syringes and they are working well. However, the Baxa syringes, as well as all other oral syringes, are not compatible with the syringe pumps, but this will probably be worked out in the future," concluded Laub.

Baxa's Web site, found at http:// http://baxa.com/helpthemgrow, features campaign information and support materials.

Julio Fernandez, Pharm.D. is a writer based in New Jersey.