ENFit Fittings, Pill Crushing, & RxCrush

Tube feeding is a therapy that supplies nutrients to people who cannot get enough nutrition through eating. Flexible tubes are inserted through various routes to deliver nutrition like through the nasal passages, to deliver liquid nutrition directly into the stomach or small intestine. Doctors usually insert the tube while you are in the hospital, but you may continue to use it outside the hospital, at home, or in a nursing facility. Tube feeding is also known as enteral nutrition and if this is provided at home, it’s usually called home enteral nutrition (HEN). Doctors use different types of feeding tubes for HEN. The type of tube used depends on the feeding route (either through the stomach or small intestine) and how long you will receive this type of nutrition. Tubes can either be nasally placed or surgically placed. If this is nasally placed, a doctor will insert a tube through your nose and pass it through your throat into your small intestines or stomach. Doctors usually recommend this route for persons who will use a feeding tube for less than 6 weeks. If it is surgically placed, a doctor will make a small incision in your belly and insert the tube into the small intestine or stomach. Doctors usually recommend this tube for people who need feeding tube/enteral access for longer than 4-6 weeks.

Many risks are associated with tube feeding. Complications may include clogged, damaged, or displaced tubes, infection at the tube insertion site, and side effects like gastrointestinal problems including constipation, nausea, diarrhea, leaking of stomach contents at the tube site, and pain at the tube site. The length of time enteral nutrition lasts varies by person. Depending on the reason for the tube, people may use a feeding tube for weeks, months, or even years. In some cases, people use a feeding tube for the rest of their lives if their injury impairs their ability to receive enough nutrition through eating.

ENfit is an international design standard to make all tube feeding devices specific to tube feeding. Every single device and item, such as the extension set, syringe, long tube or PEG, and NG-tube will be designed with an ENfit connection in order to allow you to only use products that are specifically designed for tube feeding. The button style G-tubes will not have any changes done to them, only the extension sets that connect to them.

In 2006, many of those in the enteral community expressed concerns about the possibility of cross connecting enteral feeding tubes with other tubes that can be connected to a patient. For instance, there was concern that a syringe used for tube feeding may also be used when using an IV system. Many journal articles were published and put out that included the different risks of compatible systems and their risks to the patients. There were cases of misconnections that were reported and numerous medication errors. A number of people died from the misconnections and others injured by the incorrect connections. Also current enteral feeding systems, specifically the med ports, open easily which makes it possible for children to miss feeds for hours especially if these open during the night. This is a huge inconvenience and is also a very serious problem. It took many many years for manufacturers of enteral products around the world to agree to a standard connection for worldwide use.

If a patient has a feeding tube or can’t swallow medications whole due to swallowing difficulties, medication needs to be crushed. And about 40% of all meds are only available in pill form so need to be crushed and dissolved for use in a feeding tube.

When crushing medication, it is important to perform the steps correctly so the correct dose is administered. Administering drugs through a feeding tube can be prone to errors. Medication errors related to this route of administration happen more often than reported or recognized. These errors are often a result of administering medications that are incompatible with the administration via a feeding tube, preparing the medications improperly, and administering drug-using improper administration techniques, which can lead to an occluded feeding tube, reduced drug effect, or exposure to drug toxicity. These potential adverse outcomes can lead to patient and healthcare providers harm or even death.

The RX Crush Pill Pouch is able to connect to the ENFit syringe which makes it perfect for use for those receiving enteral treatment. The liquid inside the syringe is added to the crushed medication, which is completely contained in the pill pouch. Once the mixture is shaken, it can then be transferred back to the ENFit syringe. RX Crush was able to create a design where a sealed pill crushing system delivers medication directly into a feeding tube. RxCrush Pill Pouches are compliant with the USP<800> guidelines. The pouches used are tough enough to withstand the possibility of being punctured from repeated crushing and pulverizing cycles on even the hardest pills.

The patented Rx Crush Pill Crusher connects to a syringe. Liquid from the syringe is added in with the crushed medication which is safely contained inside the pill pouch. No other additional equipment is needed. The dissolved medication is ready to be transferred to a feeding tube via the attached syringe. Here’s a look into how the Rx Pill Crusher Works:

These steps are shown in the How To video on the https://www.rxcrush.com/how-it-works web site:

  1. The pill is inserted into the pill pouch through the zip-seal bag.
  2. The water-filled syringe will be connected to the nozzle on the pill pouch.
  3. The zip-seal pouch is closed with fingers then placed under the roller. The roller is used to ensure that the pouch is sealed properly.
  4. The pill crush plate will be used to crush the pills by moving the handle up and down. This is an effective way of breaking larger or harder pills.
  5. The pouch is moved back under the roller that was used to seal the pouch. It will then be rolled back and forth to further pulverize the pills.
  6. Once further pulverization has been done, the pouch will be removed from the crusher, and water from the attached syringe will be injected into the pill pouch.
  7. While the syringe is still attached to the pouch, the pill pouch will be shaken until the medication has been dissolved.
  8. The dissolved pill solution will be drawn from the pill pouch into the syringe. It’s important that the pouch is held up to make sure that all contents of the pouch flow into the syringe.
  9. The syringe will be detached from the pill pouch. The pouch will be held down and the syringe will be pulled up to ensure that nothing leaks from the pouch. The syringe can then be attached and the contents may be injected into a feeding tube.
  10. The syringe will be refilled with water, injected into the pouch, dissolved again and with drawn and transferred to the feeding tube multiple times to remove all pill particles from the pouch.
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