Nasal Bridling of Nasoenteric Feeding Tubes

Abstract

Introduction A trend of dislodged nasogastric tubes was noted in children at a high risk for loss of enteral feeding access. There is known morbidity associated with early nasogastric tube dislodgement. Despite nursing and family education regarding the importance of these surgically placed tubes, the optimal method of securing nasogastric tubes is undetermined. Methods A nasal bridling program was implemented from February 2015 to February 2017 for pediatric surgical patients less than 1 year old requiring nasoenteric feeding tubes. The pediatric surgical service oversaw education and implementation of the program. Retrospective data collection was performed. Variables included weight and age at the time of tube placement, indications, method of placement, bridle duration, associated complications, unintended dislodgement, and diagnosis outcomes. Results Fourteen bridle systems were placed in 12 children with diagnoses including tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease with poor oral skills/feeding, and duodenal atresia and stenosis for 444 patient days. The average duration of bridling was 31.7 days per patient. Of the 14 bridles placed, only one unintended tube removal occurred. Discussion Bridling of nasoenteric feeding tubes is a safe and effective method for preventing unintended tube dislodgement, leading to improved patient care in the pediatric surgical population less than 1 year old. On the basis of our institution's results, ongoing continuing education for use and care of nasoenteric feeding tubes is recommended for the pediatric surgical population.

Nasal Tube Securement

“…Mayes et al (2020) noted that the increased rate of feeding tube reinsertion resulted in increases in sedation requirements, patient discomfort, and parent/ patient anxiety. Kang et al (2018) implemented the nasal tube securement device on 14 patients less than 1 year of age, with the average age of 30 days; however, no comparison group was used in this study. One accidental dislodgement was noted out of the 14 patients in the sample (Kang et al, 2018).…”

“…Kang et al (2018) implemented the nasal tube securement device on 14 patients less than 1 year of age, with the average age of 30 days; however, no comparison group was used in this study. One accidental dislodgement was noted out of the 14 patients in the sample (Kang et al, 2018).…”

“…Pediatric patients recovering from a traumatic brain injury (TBI) on a rehabilitation unit frequently require a nasal gastric tube for nutritional support during their early recovery phase. Accidental dislodgement is a common complication associated with the use of a nasal gastric tube and has been cited in numerous articles (Bechtold et al, 2014; Kang et al, 2018; Lynch et al, 2018; Mayes et al, 2020; McGinnis, 2011; Newton et al, 2016; Parks et al, 2013; Puricelli et al, 2016; Seder et al, 2010). When a patient requires numerous episodes of enteral feeding tube reinsertion, it increases a patient’s risk of anxiety, possible sedation (Mayes et al, 2020), and potential life-threatening events such as inadvertent placement of the tube in the lungs and pneumothorax (Gunn et al, 2009; Lyman et al, 2018; Lynch et al, 2018; Metheny et al, 2019; Stabler et al, 2018; Wathen & Peyton, 2014).…”

“…When a patient requires numerous episodes of enteral feeding tube reinsertion, it increases a patient’s risk of anxiety, possible sedation (Mayes et al, 2020), and potential life-threatening events such as inadvertent placement of the tube in the lungs and pneumothorax (Gunn et al, 2009; Lyman et al, 2018; Lynch et al, 2018; Metheny et al, 2019; Stabler et al, 2018; Wathen & Peyton, 2014). Patients recovering from a TBI, as well as other pediatric patients, are at higher risk for accidental tube dislodgement because of their impulsivity and lack of understanding of the necessity of the tube to remain in place (Kang et al, 2018).…”

“…A review of available literature indicated that the use of a nasal tube securement device has been less documented in the pediatric population as compared with the adult population (Mayes et al, 2020). Two more recent studies have found the use of a nasal securement device has been successful in decreasing dislodgements of nasal gastric tubes in the pediatric population (Kang et al, 2018; Mayes et al, 2020). Because there is a dearth of literature on the effectiveness of the nasal tube securement device in children, a randomized controlled trial was initiated to evaluate the effectiveness of this device to reduce the rate of dislodgements in the pediatric hospitalized population.…”