Nasal bridle revisited: an improvement in the technique to prevent unintentional removal of small-bore nasoenteric feeding tubes.

OBJECTIVE

To demonstrate the efficacy and safety of an updated version of the nasal "bridle," which is used to prevent the accidental removal of small-bore nasoenteric feeding tubes.

DESIGN

A descriptive study.

SETTING

Surgical intensive care unit in a tertiary care hospital.

PATIENTS

Twenty-six critically ill patients without nasotracheal tubes or facial trauma or fractures who received enteral nutrition and either had removed or were at risk for removing their properly positioned nasoenteric feeding tubes.

INTERVENTIONS

A length of one-eighth inch (3.2 mm) umbilical tape is looped around the nasal septum and vomer by serially attaching the ends of the umbilical tape to a suction catheter, passing the catheter through the nostrils, into the oropharynx, and retrieving the ends from the oropharynx. The properly positioned umbilical tape loops into one nostril around the vomer, and out the other nostril. The feeding tube is then anchored to the umbilical tape with a central venous catheter fastener clamp.

MEASUREMENTS AND RESULTS

Communicative patients denied discomfort, and there were no episodes of bleeding, infection, sinusitis, or nasal septal trauma caused by the umbilical tape bridle. Five patients had the bridle in place >30 days. There were only two cases in which the bridle failed to prevent removal of a feeding tube. One of these cases occurred because the fastener clamp anchor failed, but this patient had had the same bridle and feeding tube for 170 consecutive days.

CONCLUSIONS

An umbilical tape bridle with a central venous catheter fastener clamp anchor is a safe and effective method to prevent the accidental removal of nasoenteric feeding tubes in critically ill patients. We recommend its use in confused or uncooperative patients, or when the risk of unintentional feeding tube removal is high.