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Tubing misconnections: normalization of deviance.

Debora Simmons1, Lene Symes, Peggi Guenter

  • 11Texas Woman’s University, Houston, Texas 77030, USA.

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
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PubMed
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Accidental enteral and intravenous tubing misconnections pose a significant patient safety threat. Redesigning connectors to ensure incompatibility is recommended to prevent these dangerous errors.

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Area of Science:

  • Medical Device Safety
  • Patient Safety
  • Clinical Engineering

Background:

  • Enteral and intravenous (IV) tubing misconnections are a critical patient safety issue.
  • Universal connectors facilitate accidental connections between incompatible medical systems, leading to severe harm or death.
  • Current tubing systems allow for misconnections between enteral and IV lines, posing a significant risk.

Purpose of the Study:

  • To identify safety threats associated with enteral and IV tubing misconnections.
  • To analyze patient outcomes resulting from such misconnections.
  • To review current recommendations for preventing enteral and IV tubing misconnections.

Main Methods:

  • A comprehensive literature search was conducted on case studies of tubing misconnections.
  • Expert recommendations for safe tubing connections were analyzed.
  • Case studies and expert opinions were evaluated using models of threats and errors.

Main Results:

  • 116 case studies involving enteral-to-IV tubing misconnections were identified.
  • The primary recommendation from analyzed cases is the redesign of connectors to eliminate universal compatibility.
  • While other recommendations exist, they are insufficient to prevent all misconnections.

Conclusions:

  • Redesigning connectors for incompatibility between enteral and IV systems is strongly supported by evidence.
  • Despite substantial evidence, progress in safeguarding patients from tubing misconnections remains limited.
  • Urgent implementation of redesigned connectors is necessary to prevent patient harm.