225 The Bridle: Optimizing Enteral Nutrition and Decreasing Costs

Abstract

OBJECTIVE: The objective is to prevent inadvertent nasoenteral tube displacement by using the bridle nasal tube retaining system in the burn patient. BACKGROUND: The burn patient requires high caloric intake and often meets criteria for supplemental nutrition via nasoenteral feeding tubes. Facial burns, altered mental status, and long term use of feeding tubes contribute to nasoenteral tube removal. These removals often result in a gap of nutritional intake, radiation exposure, increased risk for aspiration, patient discomfort, and increased nursing workload. Reinsertion of enteral feeding tubes is also shown to be cost-intensive. These costs are incurred from additional tube use and radiologic procedures. Additional costs of nursing workflow are not quantifiable however. Enteral feeding tube securement is the greatest challenge in preventing tube displacement. The standard securement with twill ties, or tape, has not been proven effective in preventing dislodgement. Bridle education was provided to all burn center nurses via educational in-services, instructional video, and dissemination of a brochure reference tool from the bridle manufacturer. Bridle competency was measured by return demonstration via mannequin and patients, verbal understanding, and troubleshooting scenarios. During the three months prior to bridle initiation, there were seven patients requiring enteral nutrition via nasoenteral tube. A single nasoenteral feeding tube costs $58.80. Each abdominal radiograph and radiograph reading to confirm placement cost $72 and $26 respectively. There were eleven occurrences of inadvertent nasoenteral tube removal during this time period with a total cost of $1,423.26. These eleven occurrences required eleven abdominal radiographs to confirm tube placement. The bridle system was used in the burn center for the following four months. During that time, there were fifteen patients requiring enteral nutrition via nasoenteral tube. There were two occurrences of inadvertent nasoenteral tube removal with a total cost of $316.28. One of the dislodgments was due to user error. Therefore, there were only two abdominal radiographs related to tube dislodgement during this period. The results showed a decreased cost of $1,106.98 and decrease in abdominal radiographs occurrences related to nasoenteric tube placement. Implementation of the nasal bridle tube retaining system reduced burn center costs, decreased the occurrences of nasoenteral tube removal, and lowered patient radiation exposure. This project shows the bridle is a cost effective method of securing feeding tubes in burn patients.