Avulsed Nasoenteric Bridle System Magnet as an Intranasal Foreign Body

Safety and effectiveness of the nasal bridle securement device to retain feeding tubes in adult patients in the intensive care unit: An observational study

BACKGROUND

Nasal bridle securement devices were introduced to our adult intensive care unit (ICU) in October 2016 as an alternative for securing small-bore feeding tubes in patients at higher risk of inadvertent tube dislodgement.

METHOD

We assessed high-risk ICU patients from October 2014 to March 2019 to address three objectives. First, we prospectively monitored ICU patients with a nasal bridle for all types of adverse events. Second, we used propensity score methods to create a (1:1) matched historical comparison group (ie, tape group). We then compared the number of inadvertent tube dislodgements and the caloric intake between the tape and nasal bridle groups.

RESULTS

In the prospective group (n = 64), there were 20 adverse events, 12 of which were inadvertent tube dislodgements. Forty-eight participants in the nasal bridle group were matched with participants in the historical group. Thirty-five percent (17/48) of patients in the tape group had at least one inadvertent tube dislodgement; in the nasal bridle group, 48% (23/48) had at least one inadvertent tube dislodgement, although this only occurred in 7 of 48 (15%) patients after the nasal bridle had been inserted. The tape group achieved a lower median percentage of total caloric intake received (66.0%) compared with that of the nasal bridle group (86.1%; P = 0.017).

CONCLUSIONS

In the subpopulation of ICU patients with a small-bore feeding tube who demonstrate a higher risk of inadvertent tube dislodgement, use of the nasal bridle may be associated with a higher caloric intake, even though it does not completely prevent tube dislodgement.

Nasal Tube Securement: Randomized Controlled Trial in Pediatric Hospitalized Patients

PURPOSE

The aim of this study was to compare accidental dislodgement rates of nasal gastric tubes secured with standard methods or a nasal tube securement device in pediatric patients.

DESIGN

A randomized controlled trial was conducted.

METHODS

Participants ( n = 43) were randomized into standard securement or nasal tube securement device using block randomization to control for age and diagnosis. Surveys were collected from staff and caregivers on device ease of use and satisfaction.

RESULTS

There were a similar number of tube dislodgements for patients in the nasal tube securement device group ( n = 6) and the standard practice group ( n = 7). The median hospital length of stay was higher for the standard practice group (13 days vs. 9 days).

CONCLUSION

Use of the nasal tube securement device did not significantly decrease the rate of tube dislodgements compared with standard practice.

CLINICAL RELEVANCE TO REHABILITATION NURSING

The study provides information for pediatric rehabilitation nurses in choosing securement options for nasal gastric tubes.

ADHESION OF ASSISTANCE PROTOCOL ON NASOENTERAL CATHETER FIXATION

Objective: To verify the adherence of the nursing team to a care protocol for the fixation of a nasoenteral catheter, after a health education action. Methods: Quantitative, cross-sectional, field, observational and descriptive study in a hospital in the city of Rio de Janeiro. It consisted of two stages: health education action on a nasoenteral catheter fixation protocol and data collection after health education action, in the form of non-participant observation, using an instrument containing information regarding the presence of fixation, type of fixation, record of the date of the procedure and conditions of fixation of the nasoenteral catheter. Results: Health education actions encompassed the participation of 133 nursing professionals. Of the 123 patients observed, 100% had fixation, the most prevalent being nasal fixation (60.16%/n = 74). In 68.29% (n = 84) there was no date record, 95.93 (n=118) and 87.80% (n = 108) had good cleaning and adherence conditions, respectively. Conclusion: A satisfactory result was not achieved regarding adherence to the type of fixation and registration of the date of the procedure. Despite the unsatisfactory adherence, there was a high positive correlation between the professionals’ adherence to the education actions and the correctness ratio of the type of fixation.

ADESÃO DE PROTOCOLO ASSISTENCIAL SOBRE FIXAÇÃO DE CATETER NASOENTERAL

Objetivo:Verificar a adesão da equipe de enfermagem a um protocolo assistencial de fixação de cateter nasoenteral, após ação de educação em saúde. Método: Estudo quantitativo, transversal, de campo, observacional e descritivo, em um hospital no município do Rio de Janeiro. Constituiu-se de duas etapas: ação de educação em saúde sobre um protocolo de fixação de cateter nasoenteral e coleta de dados após ação de educação em saúde, sob a forma de observação não participante, com a utilização de instrumento contendo informações referentes à presença de fixação, tipo de fixação, registro da data do procedimento e condições da fixação do cateter nasoenteral. Resultados: As ações de educação em saúde abrangeram a participação de 133 profissionais de enfermagem. Dos 123 pacientes observados, 100% possuíam fixação, sendo a mais prevalente a fixação nasal (60,16% / n = 74). Em 68,29% (n = 84) não havia registro de data, 95,93% (n = 118) e 87,80% (n = 108) apresentavam boas condições de limpeza e aderência, respectivamente. Conclusão: Não se atingiu um resultado satisfatório quanto à adesão ao tipo de fixação e registro da data do procedimento. Apesar da adesão insatisfatória, houve alta correlação positiva entre a adesão dos profissionais nas ações de educação e razão de acerto do tipo de fixação

Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

Nasal Bridles for Securing Nasoenteric Feeding Tubes: A Review of Clinical Effectiveness and Potential Complications

Nasal bridle is a feeding tube retaining device that is now increasingly used worldwide. While common complications tend to be minor, it is important to remain vigilant for newer adverse events. We hereby delineate the case of an elderly female who required nasoenteric feeding tube following simultaneous liver-kidney transplantation. Nasal bridle placement was warranted owing to her significant frailty and poor mentation. Due to her extreme agitation during the procedure, bridle insertion could not be completed. Upon removal of the probe, unprompted detachment of the magnetic tip was noted. Radiological workup revealed the dislodged magnet in the sphenoid sinus. Subsequently, she underwent an uneventful endoscopic sinus surgery, resulting in successful retrieval of the magnet. This paper highlights the spontaneous magnet avulsion from a bridling system and serves the purpose of community awareness regarding this unusual procedural complication. Additionally, we aim to evaluate the efficacy of the nasal bridle, further accentuating its advantages and possible complications.