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Observation of inadvertent tube loss in ICU: effect of nasal bridles

10 October 2019
Focus
02 October 2019
Volume 28 · Issue 18

Abstract

Background:

safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required.

Aim:

to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ).

Method:

an observational service evaluation.

Findings:

109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape.

Conclusion:

securing a tube with a nasal bridle from day 1 is independently associated with reduced tube loss, increased duration of tube use, and likelihood that the tube would reach redundancy when it was no longer required.

Early, adequate enteral nutrition (EN) is associated with improved patient outcome and reduced duration of mechanical ventilation and length of hospital stay (Heyland et al, 2011; Compher et al, 2017). Meeting the nutritional needs of intensive care patients is complex and multifactorial: patients have increased protein demand, yet there may be inadequate protein provision in standard feeds, and patients may experience delays in feed initiation secondary to interventions and access (Taylor et al, 2016). International research of 158 intensive care units (ICU) found that about 50% of energy prescriptions and 60% of protein prescriptions are being met (Cahill et al, 2010; Cahill et al, 2014). It is, therefore, vital to ensure safe tube placement and securement, because these are prerequisites for effective EN delivery in critically unwell patients (Taylor et al, 2015).

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Nasal bridle
Tube dislodgement
Feeding tube
Securement
Enteral nutrition