How many times have you been in this situation?
You have observed your overloaded colleague during a very busy shift in the NICU. You want to assist. You ask your coworker if there is anything that you can do to help.
She asks something very simple, like, “Can you turn off my patient’s feeding? The syringe is almost empty.” You assure her that of course you will. You have now accepted the task of turning off the feeding syringe infusion pump.
However, when you walk over to the patient’s bedside to turn off the feeding pump, you are reminded that this is one of the sickest babies in the unit. He is receiving very small feeds of his mother’s breast milk. And you notice there are several (six to be exact) additional pumps infusing various fluids and medications.
The unit lighting has been dimmed to decrease stimulation, and although the syringe is labeled, you must peer closely at the labels (very small labels) to see them clearly. Some are handwritten, some are colorful, and one is illuminated by a back-light on the pump. Your challenge: identifying exactly which syringe pump is infusing the feeding.
After some time you are able to identify which pump is the “right” pump infusing the feeding, and you turn it off. Whew! You can’t help but think there must be a better way to clearly identify the feeding pump!
You are not alone.
This exact scenario plays out on a regular basis in NICUs across the country. This is especially true in the NICUs that have not implemented the best practice of having an enteral-only feeding pump in their NICU.
I share this serious scenario in a light-hearted, generic manner so that we can all get a visual, and most importantly, bring a heightened level of awareness to this situation. Many NICUs are in the process of improving enteral feeding practices, and they are updating their standards by reviewing recommendations.
What is the best practice, and recommendations, for having an enteral feeding pump?
In 2008, The Joint Commission Journal of Quality and Patient Safety released a paper emphasizing the urgency around minimizing the risk of enteral feeding misconnections, including solutions to prevent misconnections.
One of the key solutions was “…not to adapt IV or feeding devices because doing so may compromise the safety features incorporated into their design.”
This solution was broad enough to include all enteral feeding products and equipment.
A few years later, in 2014, The Joint Commission released Sentinel Event Alert, Issue #53, which clarified this recommendation when addressing effective processes and procedure: “Use tubing and related equipment only as they are intended to be used / Do not use IV pumps for enteral feedings.”
In addition, the American Society for Parenteral and Enteral Nutrition (ASPEN) Enteral Nutrition Practice Recommendations provide evidence-based guidance for improving clinical practice that includes the following:
- Do not modify or adapt IV or feeding devices because doing so may compromise the safety features incorporated into their design.
- When syringe pumps are used in neonatal ICUs for human milk or other feedings, they should be clearly distinct from syringe pumps used for IV or other medical purposes.
- Enteral feeding pumps should be a different model, color, or as different in appearance from IV pumps as possible.
- Enteral feeding pumps should be clearly labeled as enteral feeding pumps.
If you are in the process of improving practice at your facility in the pediatric or neonatal intensive care unit, it is vital to consider these recommendations. The NICU environment has long been recognized as unique and complex, with very small, critical patients, requiring many infusion pumps and lines of tubing lying within close proximity. Using evidence and practice guidelines to improve practice is our responsibility as clinicians and caregivers.
Where is your unit in this process? Do you already have all-enteral pumps, or are you transitioning? Let us know in the comments section below!