Nasal Bridling of Endoscopically Placed Nasojejunal Feeding Tubes

Abstract

Purpose: Post-ampullary, Nasojejunal feedings have been shown to be an important component in the management of critically ill patients and patients with pancreatitis. However, proximal migration or dislodgement of the tubes can occur, limiting the effectiveness of the feeding in ICU patients. Methods: Intensive care unit (ICU) patients undergoing placement of nasojejunal feeding tubes (NJT) from January 2000 to December 2005 were prospectively identified. The feeding tube was positioned endoscopically into the post ampullary duodenum. After feeding tube placement, the NJT was “bridled” with umbilical tape to the posterior nasal septum. Bridling was performed using an NG tube, advanced to the posterior pharynx and pulled out through the mouth. Umbilical tape was secured to the NG tube which was then pulled back through the nose. The bridle was then created by securing the end of the umbilical tape to the feeding tube, with the nasal septum anchoring the tube in position, limiting displacement of the NJT when pulled. Results: A total of 153 NJT were placed and bridled in 139 patients. Positioning of the feeding tube was performed using snare (32%) and rat-tooth forceps (68%). Feeding tube position was confirmed to be post pyloric endoscopically and with abdominal xray after placement. All included patients had undergone repeat abdominal films from 5–19 days after initial placement, at which time feeding tube position was reassessed. Accidental tube dislodgement or gastric proximal migration occurred in 6 cases (4%) and tube occlusion or malfunction in 3 cases (2%). There was mild nosebleeding in 2 patients (1.5%) and perinasal ulceration in 3 patients (2%). Goal tube feedings were achieved within 72 hrs. in 142 cases (93%). Conclusions: Nasal Bridling of endoscopically placed NJT maintains post pyloric feeding tube position at a high rate (94%), with very few complications. This allows for rapid delivery of optimal nutrition in ICU patients.