title: Gravity Flow in Proposed Enteral Tube Small-Bore Connectors.
abstract: BACKGROUND
  Enteral nutrition (EN) misconnections have been identified as a serious and potential deadly problem. An international effort led by EN industry leaders has developed a small-bore enteral connector (ENFit) that in theory will reduce the frequency of misconnections. Despite the potential benefit of preventing misconnections, the full impact of adoption of the ENFit connector is unknown. To assess the impact of transitioning to ENFit on our home EN (HEN) patients, the current study evaluated gravity feeding comparing 2 proposed small-bore connectors to the legacy (current connector) using various commercial formulas.
  
  
  METHODS
  Six commonly used enteral formulas in our facility with varying density and viscosity were tested in triplicate. Forty milliliters of formula was poured into a syringe connected to an ENFit or legacy (current) feeding connector attached to varying French size tubes. The time it took formula to flow through the connectors was recorded, and the test was repeated in triplicate.
  
  
  RESULTS
  All formulas took significantly longer to flow through the first ENFit connector compared with the legacy connector ( P < .05). The second ENFit connector demonstrated similar flow dynamics to the legacy connector.
  
  
  CONCLUSIONS
  There is wide variability in the flow dynamics in ENFit connectors with significant potential impact on many facets of HEN, including medicine delivery, blenderized feeds, venting, and compliance with EN due to increased time to administer feeds. We highly recommend additional testing of flow dynamics, including gravity flow, as ENFit tubes are being developed and adopted.
authors.affiliation: 1 General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.|2 Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.|3 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.|4 Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
authors.affiliation: 3 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Epp
authors.affiliation: 3 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Adele K
authors.initials: AK
authors.lastname: Pattinson
authors.affiliation: 3 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Wanda M
authors.initials: WM
authors.lastname: Duellman
authors.affiliation: 5 Division of Engineering, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Corner
authors.affiliation: 3 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Mundi
mesh_terms: D004040:Dietary Carbohydrates / Q000032:analysis; D004041:Dietary Fats / Q000032:analysis; D004043:Dietary Fiber / Q000032:analysis; D004044:Dietary Proteins / Q000032:analysis; D004750:Enteral Nutrition / Q000295:instrumentation*; D004867:Equipment Design; D006112:Gravitation; D007441:Intubation, Gastrointestinal; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D014783:Viscosity
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D004044:Dietary Proteins; D057947:Parenteral Nutrition Solutions
keywords: enteral nutrition; home care; home nutrition support; nutritional support; tube feedings