Tubing Misconnections Remain a Threat Amid Slow ENFit and NRFit Adoption
Hazard #5—Top 10 Health Technology Hazards for 2026
Each year, ECRI produces a Top 10 Health Technology Hazards report to identify potential sources of danger involving the use of medical devices and systems and to present practical recommendations for reducing the risks. In the 2026 edition, the hazard “Tubing Misconnections Remain a Threat Amid Slow ENFit and NRFit Adoption” occupies the No. 5 spot on the list.
In that report, ECRI describes how the physical compatibility of Luer-lock connectors on devices and lines intended for different purposes creates an environment in which misconnections can—and do—occur. Deaths have resulted, for example, from enteral feeding solution mistakenly being delivered into the vasculature through an IV line.
The organization notes that safer connector designs that prevent tubing misconnections in certain applications are available—specifically ENFit connectors for enteral applications and NRFit connectors for neuraxial ones. These products are widely used in many parts of the world, but adoption in the United States remains low, putting patients at unnecessary risk. ECRI encourages facilities to transition to these safer connectors.
To learn more, visit Top 10 Health Technology Hazards for 2026 Executive Brief to obtain a complimentary copy of an Executive Brief of the report. Members of ECRI programs can also access the full report, which includes additional information about the hazard and detailed recommendations for action, through their ECRI member web pages.
