Nasal bridle insertion is more invasive than securing an enteric feeding tube with tape or an adhesive product, and it does increase the cost of enteral feeding tube insertion. The nasal bridle loop retention system is technically easy to insert and usually takes less than 10 minutes, with most procedures completed in 5 minutes or less. Once the clip is closed, a knot should be tied in the silicone tape just peripheral to the clip and the excess cut off.Important: the clip should not contact the nostril as it may cause pressure necrosis (Figure 2). The clip should be positioned approximately 1cm (1/2") from the nostril. Position the silicone tape adjacent to the feeding tube before closing a compression clip around both.Cut the catheter portion from the silicone tape and discard the catheter and probe.This creates a loop around the vomer bone (Figure 1). Continue until only the silicone tape remains in the nose, with each end exiting out one nostril. Slowly withdraw the blue probe and allow the catheter to advance through the nose, exiting the nares opposite the feeding tube.Remove the stiffener from the bridle catheter. A “click” will be felt when the magnets connect.If necessary, the orange stylet in the catheter should be pulled back about 1cm (1/2") until the magnets connect.
The catheter is inserted into the nostril with the feeding tube, tip directed to the midline, to approximate the magnets. The shaping of the wire makes the bridle catheter directional if catheter manipulation is needed to find the magnetic tip of the probe. The stiffening wire is gently bent into a hockey-stick shape and inserted into the bridle catheter, above the connection to the silicone tape and prior to placement in the nares (Figure 1).The probe and catheter are both directed posteriorly, not superiorly, in the nares, to extend posterior to the vomer bone. The blue probe is inserted into the nostril opposite the feeding tube until the second ring is positioned at the bottom of the nostril (note: shorter depth is required for infants and small children). The tips of the blue probe and catheter (Figure 1) with inner stylet are lubricated.The child is placed in the supine position, and the procedure is performed as follows: The nasal bridle may be placed before or after the nasal tube we prefer placing it after the NJ tube to prevent an unnecessary procedure if feeding tube insertion is unsuccessful. Placing a nasal bridle requires neither imaging guidance nor sedation. The nasal bridle loop retention device (Applied Medical Technologies, Brecksville, Ohio) provides a more reliable method of securing a feeding tube for long periods of time. Replacing a feeding tube may require sedation or general anesthesia, especially in children, as well as additional radiation, particularly for NJ tube insertion where fluoroscopic guidance may be required. They may also be prematurely removed entirely, necessitating a repeat placement. Unfortunately, tube security with these dressings may be poor, and tubes are often inadvertently retracted into unsafe positions, such as in the esophagus for NG tubes or in the proximal duodenum or stomach for NJ tubes. Historically, various types of taping and adhesive dressings were used to fix the feeding tube in position. The target for tip position for an NG tube is generally within the gastric fundus, while the preferred tip position for an NJ tube is in at least the fourth portion of the duodenum to minimize the risk of fluid reflux into the stomach. Nasogastric and NJ feeding tubes are especially useful for nutritional supplementation for short-to-medium periods of time (<6 weeks) because they reduce the need for more invasive and expensive procedures, including surgical, endoscopic, or percutaneous gastrostomy or gastrojejunostomy.Īfter initial placement of a feeding tube, the main challenges are to maintain the tip of the feeding tube in a safe and effective position and to minimize inadvertent removal by the patient or staff. Tube feeding can be an excellent option for any patient with a functional gastrointestinal tract, thereby avoiding intravenous hyperalimentation and its associated complications. The use of nasogastric (NG) and nasojejunal feeding tubes (NJ) has steadily increased over the past 20 years as they have become important approaches to providing adequate calories and hydration for children, older adults, and others who have temporary or long-term need for alternate pathways for nutrition.
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