What does it mean to bridge the Nasogastric (NG) tube?

From the Guidelines

Bridling an NG tube is a technique used to secure the tube in place by passing a suture or bridle through both nostrils and attaching it to the tube, which is recommended for patients who require long-term enteral feeding or are at high risk of pulling out their tube. This method is particularly important for preventing accidental dislodgement of the NG tube, which can lead to complications such as aspiration pneumonia. According to the most recent and highest quality study 1, a nasal loop/bridle may be applied to secure the nasogastric tube if it is repeatedly removed accidentally by the patient and if enteral nutrition will probably be necessary for more than 14 days. The procedure involves creating a loop that passes behind the nasal septum and securing the NG tube to this bridle using suture material or a specialized clip system.

Some key points to consider when bridling an NG tube include:

• The bridle is generally well-tolerated by patients and can remain in place for extended periods 1
• Healthcare providers should regularly check for signs of pressure or irritation at the nares 1
• Bridling is typically performed by trained healthcare professionals such as nurses, physicians, or dietitians with specific training in the technique
• The use of nasal bridles has been shown to have few complications and minimal discomfort 1

Overall, bridling an NG tube is a effective method for securing the tube in place and preventing accidental dislodgement, and is recommended for patients who require long-term enteral feeding or are at high risk of pulling out their tube 1.

From the Research

Bridling the NG Tube

• Bridling the NG tube refers to the use of a nasal bridle, a device used to secure nasoenteric feeding tubes in place, preventing dislodgement and ensuring continuous feeding or medication administration 2, 3.
• The nasal bridle is a more reliable system for securing enteral feeding tubes compared to traditional methods using adhesive tape alone, with studies showing a statistically significant reduction in tube dislodgement 2.
• However, the use of nasal bridles has also been associated with a higher rate of skin complications, such as external nasal ulceration and epistaxis, compared to traditional adhesive tape 2, 3.
• The incidence of sinusitis was found to be no different between the two groups, although one study reported a case of spontaneous magnet avulsion from a bridling system, resulting in the dislodged magnet being found in the sphenoid sinus 4.

Clinical Effectiveness and Potential Complications

• Despite the advantages of nasal bridles, there is insufficient evidence to suggest one securing technique or device over another, and more research is needed to establish the most effective method for securing nasoenteric tubes 3.
• The use of nasal bridles may also have cost-saving benefits, with one study finding that routine bridling of nasoenteric feeding tubes resulted in cost savings 3.
• It is essential to be aware of the potential complications associated with nasal bridles, including skin complications and rare cases of magnet avulsion, to ensure safe and effective use 4.

Administration of Medications via NG Tube

• Administering oral medications via nasogastric tube (NGT) can be challenging, and inappropriate prescribing behavior or incorrect procedure for extemporaneous preparation of oral suspensions can result in significant harm to patients 5.
• There is evidence to show that NGT dosing of some medications may bring both benefits and disadvantages, and physicians, pharmacists, and nurses should be aware of the procedures for drug administration by NGT, as well as the latest evidence on such administrations 5.
• Recent updates in research regarding nasogastric tubes highlight the importance of safe and effective insertion, maintenance, and management of complications associated with NGT use 6.