The Routine Bridling of Nasojejunal Tubes Is a Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit

Abstract

Purpose: To determine if the routine bridling of nasoenteric feeding tubes in the intensive care unit is a low-morbidity, cost-effective method of decreasing tube dislodgement. Methods: Data were prospectively collected from 62 consecutive bridled patients and compared with that from 172 consecutive unbridled patients for differences in tube dislodgement, nasal ulceration, and estimated cost. Results: Bridled patients demonstrated significantly less tube dislodgement (6.5% vs 32.6%, P < .0001). Bridling resulted in 4 cases of nasal ulceration per 800 tube feeding days, all of which were associated with red rubber catheter bridles. Conversion to 1/8-in umbilical tape bridles eliminated ulceration and further reduced dislodgement from 10% to 4.8%. Implementation of bridling saved an estimated $4038 over 3 months. Conclusions: Nasal bridling is a simple, cost-effective practice that may reduce the rate of nasoenteric tube dislodgement. The use of 1/8-in umbilical tape may be more effective and safer than 8-Fr red rubber catheters for this purpose.

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References

Damore LJ, Andrus CH, Herrmann VM, Wade TP, Kaminski DL, Kaiser GC. Prospective evaluation of a new through-the-scope nasoduodenal enteral feeding tube. Surg Endosc. 1997 ;11(5):460 -463.

McClave SA, Sexton LK, Spain DA, et al. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med. 1999 ;27(7):1252 -1256.

Lee SS, Mathiasen RA, Lipkin CA, Colquhoun SD, Margulies DR. Endoscopically placed nasojejunal tubes: a safe route for enteral nutrition in patients with hepatic encephalopathy. Am Surg. 2002 ;68(2):196 -200.

McWey RE, Curry NS, Schabel SI, Reines HD. Complications of nasoenteric feeding tubes. Am J Surg. 1988 ;155(2):253 -257.

Kawati R, Rubertsson S. Malpositioning of fine bore feeding tube: a serious complication. Acta Anaesthesiol Scand. 2005 ;49(1):58 -61.

Armstrong C, Luther W, Sykes T. A technique for preventing extubation of feeding tubes: “the bridle.” JPEN J Parenter Enteral Nutr. 1980 ;3:603 .

Popovich MJ, Lockrem JD, Zivot JB. Nasal bridle revisited: an improvement in the technique to prevent unintentional removal of small-bore nasoenteric feeding tubes. Crit Care Med. 1996 ;24(3):429 -431.

Brandt CP, Mittendorf EA. Endoscopic placement of nasojejunal feeding tubes in ICU patients. Surg Endosc. 1999 ;13(12):1211 -1214.

Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P, Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003 ;27(5):355 -373.

10.

Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001 ;74(4):534 -542.

11.

Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ. 2001 ;323 (7316):773 -776.

12.

Jabbar A, Chang WK, Dryden GW, et al. Gut immunology and the differential response to feeding and starvation. Nutr Clin Pract. 2003 ;18(6):461 -482.

13.

Villet S, Chiolero RL, Bollmann MD, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005 ;24(4):502 -509.

14.

Benya B, Langer S, Morbarhan S. Flexible nasogastric feeding tube tip malposition immediately after placement. JPEN J Parenter Enteral Nutr. 1990 ;14(1):108 -109.

15.

Lipman TO, Kessler T, Arabian A. Nasopulmonary intubation with feeding tubes: case reports and review of the literature. JPEN J Parenter Enteral Nutr. 1985 ;9(5):618 -620.

16.

Iyer VS, Reichel J. Perforation of the esophagus by a fine feeding tube. N Y State J Med. 1984 ;84(2):63 -64.

17.

Siegle RL, Rabinowitz JG, Sarasohn C. Intestinal perforations secondary to nasojejunal feeding tubes. AJR Am J Roentgenol. 1976 ;126(6):1229 -1232.

18.

Düthorn L, Schulte Steinberg H, Hauser H, Neeser G, Pracki P. Accidental intravascular placement of a feeding tube. Anesthesiology. 1998 ;89(1):251 -253.

19.

Wyler AR, Reynolds AF. An intracranial complication of nasogastric intubation: case report. J Neurosurg. 1977 ;47(2):297 -298.

20.

Anderson MR, O'Connor M, Mayer P, O'Mahony D, Woodward J, Kane K. The nasal loop provides an alternative to percutaneous endoscopic gastrostomy in high-risk dysphagic stroke patients. Clin Nutr. 2004 ;23:501 -506.

21.

Shah R, Janczyk RJ. Identification of risk factors leading to complications after PEG insertion in surgical intensive care unit patients. Paper presented at: 54th Annual Meeting of the Michigan Chapter of the American College of Surgeons; May 17,2007 ; Traverse City, Michigan.

22.

Safadi BY, Marks JM, Ponsky JL. Percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am. 1998 ;8(3):551 -568.

23.

Gossner L, Keymling J, Hahn EG, Ell C. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial. Endoscopy. 1999 ;31(2):119 -124.