Removal Of Feeding Tube Research Articles

Long-term clinical outcomes of supracricoid partial laryngectomy with cricohyoidoepiglottopexy for glottic carcinoma

Background: Laryngeal carcinoma should be treated with the intent of organ-sparing, and supracricoid partial laryngectomy with cricohyoidoepiglottopexy (CHEP) might be an important option.Aims/objectives: The purpose of this study was to evaluate the clinical outcomes of glottic carcinoma patients treated with CHEP.Materials and methods: A series of 164 cases with glottic carcinoma undergoing CHEP from 2006 to 2010 was retrospectively analyzed.Results: The 10-year overall survival (OS) rate, disease-specific survival (DSS) rate, and disease-free survival (DFS) rate were 77.6%, 78.8%, 74.1%, respectively. The OS, DSS, and DFS of patients with stage T1 were higher than patients with stages T2 and T3. Patients with locoregional recurrence and distant metastases had lower OS and DFS than patients with neither recurrence nor metastasis. The DFS of patients with advanced laryngeal carcinoma was worse than that of patients with early-stage carcinoma. T2 and T3 stages, locoregional recurrence, and distant metastases had predictive value regarding patient survival. Additionally, the decannulation rate of postoperative patients was 95.1%, and the nasogastric feeding tube removal rate was 100%.Conclusions and Significance: CHEP provided reliable oncologic and functional outcomes, and it should be considered as a standard function-sparing option for glottic T1b, T2, and selected T3 carcinoma patients.

What should we expect from robotic surgery for second primary oropharyngeal cancer?

The outcomes of second primary oropharyngeal cancer (SPOPC) may not be determined by oropharyngeal cancer but from the other index cancer as well. The management of (SPOPC) remains inconclusive and limited. Transoral robotic surgery (TORS) to maximize the functional outcomes without reducing oncologic effect is suggested as the primary treatment for selected oropharyngeal cancer. This study aimed to evaluate the feasibility and outcomes of TORS for the management of SPOPC. Patients who underwent TORS from January 2011 to June 2015 at a tertian referral center in Taiwan were recruited. Loco-regional status, overall survival (OS), disease-specific survival (DSS), and postoperative functional status were evaluated. Fifteen patients received TORS for SPOPC with curative intent, including eleven with tongue-base carcinomas, and four with tonsil carcinomas. One case was terminated because of inadequate exposure and the other 14 cases were completed with negative pathologic margins. Two-year OS and DSS were 53 and 77%, respectively. Patients with SPOPC occurring within 6months had poorer outcomes (p=0.044). The median time to feeding-tube removal was 5days, and one patient had long-term gastric-tube dependence. Patients of age <65years with synchronous SPOPC and esophageal cancer as the other index cancer were significant worse in oncologic outcomes. We concluded that TORS is a feasible alternative treatment in selected patients with SPOPC. Patients with metachronous T1-2 SPOPC without an esophageal primary can achieve excellent survival after TORS, while TORS can maximize functional preservation with limited destruction in patients with low life expectancy.

Duct-to-mucosa pancreatojejunostomy is a safe technique of reconstruction after pancreatoduodenectomy

Background: A duct-to-mucosa pancreatojejunostomy is technically difficult to perform than Dunking procedure after pancreatoduodenectomy. In contrast, the incidence of anastomotic dehiscence is more in Dunking than duct-to-mucosa procedure. Duct-to-mucosa technique is rarely practiced in our country because of technical difficulties and lack of experiences. Objectives: This study was undertaken to evaluate the safety of duct-to-mucosa procedure in our patients with pancreatoduodenectomy. Methods: We have performed pancreatojejunostomy in 14 consecutive patients using a duct-to-mucosa technique and the result was assessed. Results: No patients developed pancreato-jejunal leakage; however, 6 of 14 patients developed complications not related to operative techniques (wound infections; 3,jejunal fistula following removal of jejunal feeding tube; 1, renal dysfunction; 1, delayed gastric emptying; 1) which were managed conservatively. There were no postoperative deaths in the present series and the median postoperative hospital stay was 20.3 days. The follow-up period ranged from 1 to 12 months and all patients are surviving with good health during this period. Conclusion: Pancreatojejunostomy by duct-to-mucosal technique is a safe method of pancreatojejunostomy after pancreatoduodenecytomy.

Development and characterization of a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog.

To develop and describe a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog. Prospective technique development study. University teaching hospital. Six healthy adult male Beagles. Following anesthetic induction, fluoroscopic and ultrasound guidance were used to identify an appropriate gastropexy site on the left lateral abdomen. Gastropexy was performed using gastrointestinal suture anchors. An over-the-wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual-lumen gastrojejunal feeding tube was placed via serial over-the-wire dilation of the body wall using an 18F peel-away introducer kit. Tube location was determined radiographically immediately following placement and on days 2, 4, after emesis on day 4, and at time of gastrojejunal feeding tube removal (day 16-18). Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs. Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9-93 minutes). Median total procedure time was 53 minutes (range, 49-113 minutes). Significant tube migration was not observed at any point during the study. One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component. Other complications were minor and included mild-to-moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1 dog. Feedings were well tolerated in all dogs. PRGJ tube placement in the dog is a safe and minimally invasive technique that allows for jejunal feeding without surgery or endoscopy. The high success rates, acceptable procedural times, and minimal complications are appealing for use in critically ill patients. Although additional evaluations are needed, PRGJ tube placement may be considered for dogs that require postpyloric feeding with or without gastric decompression.

Myasthenia gravis: descriptive analysis of life-threatening events in a recent nationwide registry.

Myasthenia gravis (MG) may become life-threatening if patients have respiratory insufficiency or dysphagia. This study aimed to determine the incidence, demographic characteristics, risk factors, response to treatment and outcome of these life-threatening events (LTEs) in a recent, population-based sample of MG patients. A retrospective analysis of MG patients who presented with an LTE between 2000 and 2013 was performed. Participants were identified from a neuromuscular diseases registry in Spain that includes 648 patients with MG (NMD-ES). Sixty-two (9.56%) patients had an LTE. Thirty-two were classified as class V according to the MG Foundation of America, and 30 as class IVB. Fifty per cent were previously diagnosed with MG and median duration of the disease before the LTE was 24 months (3-406). The most common related factor was infection (n = 18). All patients received intravenous human immunoglobulin; 11 had a second infusion and six had plasma exchange. Median time to feeding tube removal was 13 days (1-434). Median time to weaning from ventilation was 12 days (3-176), and it was significantly shorter in late onset MG (≥50 years) (P = 0.019). LTEs improved <2 weeks in 55.8% but did not improve until after 1 month in 20% of patients. Four patients died. No other factors influenced mortality or duration of LTEs. The percentage of LTEs in MG patients was low, particularly amongst those previously diagnosed and treated for the disease. The significant percentage of treatment-resistant LTEs indicates that more effective treatment approaches are needed for this vulnerable sub-population.

OC-063 Pharyngeal Electrical Stimulation (pes) In Dysphagia Post-acute Stroke: A Double-blind, Randomised Trial

IntroductionPharyngeal Electrical Stimulation (PES) is known to activate pharyngeal motor pathways. It has shown promise in acute stroke pilot studies, having improved swallowing function at 2-weeks.1,2MethodsWe aimed to recruit 100...

Percutaneous Endoscopic Gastrostomy Tube Replacement

BackgroundEnteral feeding should be considered for patients with an intact and functional gastrointestinal tract. Percutaneous endoscopic gastrostomy (PEG) tube placement is indicated in patients requiring medium to long term enteral feeding (>30 days) and with impaired swallowing. Previously placed PEG tube can dislodge or be inadvertently removed, blocked, or damaged. Gastrostomy tube replacement is not infrequently performed. Patients and methodsIn this video manuscript, the author demonstrates step-by-step PEG tube replacement in several clinical scenarios: standard gastrostomy feeding tube (with internal retention balloon or with internal collapsible bumper) removal and replacement; low-profile feeding tube replacement; and feeding tube replacement over a wire guide. ConclusionsPEG tube replacement can be easily replaced at bed-side in most cases. Occasionally, in difficult cases gastrostomy feeding tube replacement needs endoscopic guidance and assistance.

Factors associated with supracricoid laryngectomy functional outcomes

Supracricoid partial laryngectomy (SCPL) is an option for laryngeal cancer resection that preserves laryngeal function; however, little information exists regarding factors that are associated with functional outcomes. A medical chart review was performed on patients that underwent SCPL at our institution between 2006 and 2011. Data were collected on surgical, voice, and swallowing outcomes. Eighteen patients were identified. Thirteen underwent cricohyoidoepiglottopexy (CHEP) and 5 had a cricohyoidopexy (CHP). Mean follow-up was 737 days. On average, decannulation occurred at 27.4 days and feeding tube removal at 87.9 days postoperatively. Sixty-seven percent of patients tolerated an unrestricted diet at follow-up. Increased age and a CHP procedure were associated with negative outcomes. Age may be a proxy for more extensive disease and prior treatments. Patients who undergo an SCPL require extensive rehabilitation after surgery. Those who have undergone multiple cancer interventions and have more extensive surgery may be at risk for poorer outcomes.

Sparing the larynx and esophageal inlet expedites feeding tube removal in patients with stage III‐IV oropharyngeal squamous cell carcinoma treated with intensity‐modulated radiotherapy

To evaluate the effect of larynx and esophageal inlet sparing on dysphagia recovery after intensity-modulated radiotherapy (IMRT) for stage III-IV oropharyngeal squamous cell carcinoma. Retrospective study. Of 88 patients treated with IMRT, 38 were planned with a larynx + esophageal inlet mean dose <50 Gy constraint, 27 with a larynx alone mean dose constraint of <50 Gy, and 23 without a larynx/esophagus constraint. All had a percutaneous endoscopic gastrostomy (PEG) tube placed before IMRT, which was removed when the patient could swallow and maintain weight. All IMRT plans were retrieved, and the larynx; esophageal inlet; and superior, middle, and inferior constrictors were contoured. Dosimetric data were correlated with PEG tube dependence duration. The PEG tube was removed within 3, 6, 9, and 12 months after IMRT in 24%, 61%, 71%, and 83% of patients, respectively. Median times to PEG tube removal were 3.7 and 8.6 months (P = .0029) in patients planned with or without a larynx/larynx + esophageal inlet dose constraint. A mean dose to the larynx + esophageal inlet of ≤60 Gy reduced the median PEG tube duration from 10.8 to 6.1 months (P = .02), compared to >60 Gy. Mean pharyngeal constrictor doses in patients receiving a mean dose to the larynx + esophageal inlet of ≤50 Gy versus >50 Gy were: 60 Gy and 69 Gy, 55 Gy and 67 Gy, and 47 Gy and 57 Gy, for the superior, middle, and inferior constrictors, respectively (P < .0001). A dose constraint on the larynx and esophageal inlet during IMRT planning reduces dose to pharyngeal constrictors and expedites PEG tube removal.

Supracricoid Partial Laryngectomy

The aim of this study was to analyze the functional and oncologic results of supracricoid partial laryngectomy. Case series with chart review. Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. The medical records of 56 patients, who underwent supracricoid partial laryngectomy between March 2002 and December 2010, were reviewed in this study. Forty-three patients underwent supracricoid partial laryngectomy with cricohyoidopexy, and 13 patients underwent cricohyoidoepiglottopexy. The overall and disease-specific survival, local control rates, and the mean time of decannulation and nasogastric tube removal were evaluated. Association of type of surgery with the functional and oncologic outcomes was evaluated and statistically compared. The median follow-up period was 58 months. The 1-, 3-, and 5-year overall survival rates were 100%, 96.4%, and 82.1%, respectively. The 1-, 3-, and 5-year local control rates were 100%, 96.1%, and 92.5%, respectively. Type of surgery did not show any significant difference in survival and local control rates (P = .546, P = .455). The mean (SD) decannulation and nasogastric feeding tube removal time was 11.43 (2.03) and 16.79 (3.51) days, respectively. The mean time of decannulation and nasogastric tube removal was significantly longer in patients who underwent cricohyoidopexy when compared with those who underwent cricohyoidoepiglottopexy (P = .002, P = .000). Although delaying deglutition functions could be termed a disadvantage of supracricoid laryngectomy, especially with cricohyoidopexy, supracricoid laryngectomy has reliable oncologic and functional results for locally advanced laryngeal cancers while maintaining laryngeal functions.

Endoscopic lumen restoration for obstructive aphagia: outcomes of a 25-year experience

After chemoradiation therapy for head/neck cancer, some patients develop strictures that progress to complete pharyngoesophageal occlusion. Total lumen occlusion is less often due to other conditions. Enteral access (enterostomy tube) and good nutritional status tend to minimize the significance of dysphagia and therefore may mask recognition of impending complete lumen occlusion. Review outcomes of a 25-year experience with endoscopic lumen restoration (ELR) in 30 patients. Retrospective, case review study. Two tertiary-care referral centers. This study involved 30 consecutive patients referred for obstructive aphagia due to complete lumen occlusion, primarily after chemoradiation therapy for head/neck cancer. Antegrade and retrograde endoscopy with tri-plane fluoroscopy for penetrating the occluded segment, serial retrograde and antegrade dilations, plus swallowing rehabilitation therapy. Restoration of lumen patency, swallowing function, and removal of enteral feeding tube. ELR was successful in 30 patients in 31 of 33 attempts (93%). Return to soft to regular diet was achieved in 15 of 30 patients (50%), and fluids to pureed food with partial percutaneous endoscopic gastrostomy nutrition was achieved in 5 of 30 patients (17%). Ten of 30 patients (33%) were considered unsafe for oral feeding because of oropharyngeal neuromotor deficits. Complications occurred in 5 of 30 patients (17%), with no prolonged sequelae, deaths, or surgery, but two stents were placed for anastomotic fistulas. The median duration of follow-up was 22.75 months. Retrospective, case review study. ELR by using tri-plane fluoroscopic guidance with antegrade and retrograde endoscopy and serial dilations allows lumen restoration and swallowing to some degree in a majority of patients. Engagement of a core team of specialists can provide optimal restoration of swallowing function.

Larynx and Esophageal Inlet Sparing Expedites Recovery from Dysphagia and Feeding Tube Removal in Patients with Stage III-IV Oropharyngeal Squamous Cell Carcinoma Treated with IMRT

Larynx and Esophageal Inlet Sparing Expedites Recovery from Dysphagia and Feeding Tube Removal in Patients with Stage III-IV Oropharyngeal Squamous Cell Carcinoma Treated with IMRT

Voice and Swallow after Supracricoid Partial Laryngectomy

Objective: 1) Evaluate the long-term voice and swallowing outcomes of supracricoid partial laryngectomy (SCPL). 2) Determine the effect of prior radiation therapy on voice and swallow outcomes. Method: A retrospective chart review was performed on all patients that received SCPL at our institution between 2006 and 2010. Multiple parameters measuring voice and swallowing outcomes were recorded where available and descriptive statistics performed. Chi-square and Student t-test analysis were performed with P &lt; .05 used to denote significance. Results: Fourteen patients were identified, including 2 cricohyoidopexies and 11 cricohyiodoepiglottipexies. Mean follow-up was 650 ± 470 days. Decannulation occurred at 30 ± 16 days and feeding tube removal at 87 ± 43 days postoperatively. All patients tolerated regular diets and thin liquids. Maximum phonation time was 10.6 ± 6.1 sec, F0 was 161.7 ± 75.7 Hz, VHI was 35.6 ± 16.1, and CAPE-V dysphonia score was 56.3 ± 11.0. Comparing previously irradiated patients with those without prior radiation, there was no difference in time to feeding tube removal (100 ± 18 vs 79 ± 8 days, P = .32), maximum phonation time (9.3 ± 2.1 vs 12.6 ± 3.9 sec, P = .49) or VHI score (32.5 ± 9.4 vs 49.3 ± 1.8, P = .17), but F0 was significantly higher (235.5 ± 27.3 vs 115.1 ± 9.8 Hz, P = .01). Conclusion: SCPL is well tolerated; patients have excellent swallowing and serviceable voice postoperatively. Preoperative radiation therapy appears to raise F0; otherwise voicing and return of swallow function is similar to those patients who have not been irradiated. Prospective studies may define other prognostic markers for voice and swallow outcomes after SCPL.

Indicadores de qualidade para o gerenciamento da disfagia em Unidades de Internação Hospitalar

This article proposes a panel of quality indicators for the management of swallowing rehabilitation (SR) therapy in a hospital setting. There were four stages in developing these indicators: identifying procedures to be managed; generating indicators and standardizing data collection; identifying the correlation among indicators; and formulating the panel of indicators. The following 12 quality indicators were developed: swallowing evaluation index; individual care index; speech-language pathologist (SLP) care index; number of assisted patients index; severity rate; swallowing diagnosis rate per hospital unit; swallowing rehabilitation demand index; time until first swallowing evaluation; SLP index per hospital bed; time until removal of feeding tube; time until reintroduction of oral feeding; and time until decannulation. The proposed indicators were designed to improve the management of dysphagia in a hospital setting. Measuring these indicators is essential to understanding the patient's needs and providing quality care. Managing care using these indicators will make it easier to track the patient's rehabilitation process, measure the effectiveness of new therapeutic processes and technologies, and evaluate the performance of hospital units relative to other providers in the area. The management of SR using quality indicators allows the effectiveness and efficiency of rehabilitation programs to be clearly evaluated.

The Feeding Tube Bridle: One Inexpensive, Safe, and Effective Method to Prevent Inadvertent Feeding Tube Dislodgement

Nasally placed feeding tubes are heavily relied on in healthcare. Inadvertent tube removal not only poses safety hazards and discomfort for the patient, but also causes strain on valuable healthcare resources. Because use of restraints can agitate patients, increase safety hazards, and create a sense of depersonalization, alternative methods to prevent inadvertent tube removal are desirable. This article describes a feeding tube bridle constructed with supplies that are inexpensive and readily available to most patient care units. This method has been successfully utilized for patients at significant risk for self-initiated feeding tube removal in one Midwestern facility for many years without adverse effects. The method of bridling feeding tubes described here is effective, safe, and relatively comfortable as well as minimally noticeable to the patient and others.

Predictors of Returning to Oral Feedings After Feeding Tube Placement for Patients Poststroke During Inpatient Rehabilitation

Objectives: To identify the frequency and characteristics of patients admitted to inpatient rehabilitation (IPR) following a stroke who are able return to oral feedings and have their feeding tube (FT) removed prior to discharge from IPR, the timing of FT removal, and implications for outcomes. Methods: Medical records were identified by admission rehabilitation impairment code (RIC) for stroke (RIC 01), and reviews were completed by two physiatrists and two speech language pathologists. At random, 25% of the charts were reviewed by a second rater for data quality control. Measures collected during the chart review included the following: age, gender, onset of stroke, rehabilitation length of stay (LOS), admission and discharge FIM™, discharge destination, diet level, and feeding tube status. Results: One hundred forty-three patients were identified as subjects for this investigation who had an FT and were NPO upon IPR admission. Overall, 46.9% (67/143) of the patients returned to three meals daily prior to discharge from IPR. The mean days post stroke onset until returning to three meals daily was 38.43 days (SD = 26.36). Twenty percent (30/143) of the patients were able to have their FT tube removed prior to discharge from IPR. Factors associated with returning to three meals included gender (ie, female), longer IPR LOS, and higher admission FIM™ scores at IPR. Factors associated with removal of the feeding tube included a longer IPR LOS and younger age. Patients who were able to have their FT removed were more likely to be discharged to home. Conclusion: Individuals with longer IPR LOS were more likely to return to three meals daily and have their feeding tubes removed prior to discharge.

S1350 Efficacy of Nasal Bridles in Preventing Nasogastric Tube Displacement. the Royal Berkshire Experience

Introduction Rates of accidental removal of nasogastric feeding tubes (NGT) within hospital can reach up to 60% which exposes patients to risk from repeat procedures as well as consuming resources. Nasal bridles are not routinely used in the UK despite demonstrating a reduction in NGT removal rates, reducing the occurrence of unnecessary percutaneous gastrostomy (PEG) placements and increasing nutrition delivery. At the Royal Berkshire Hospital patients are deemed suitable for bridle placement if three or more NGT have been removed unintentionally, there is no history of nasal trauma and not so confused as to risk causing themselves nasal septal injury. All patients are assessed by a clinical nurse specialist. It is Trust policy to confirm all NGT placements with a chest x-ray. We audited our practice to assess whether bridles are effective and safe. Methods Database records for all patients referred for NG bridles between June 2007 and September 2009 were reviewed. Where additional information was required, case notes were obtained. Radiology exposure was also assessed. Results fifty-one patients were referred for bridle placement during the 27-month audit period. Median age was 72 years (range 36–90). Cerebrovascular accident was the most common reason for referral (82%). All patients had had at least 3 NGT placed prior to referral (median 3 range 3–8). 38 of the 51 patients (74.5%) had bridles attached using 39 devices in total. One patient required bridle replacement and only one experienced significant nasal trauma. The reasons for not placing a bridle included; 2 were too unwell, 6 were already eating, 3 refused and 2 were too difficult to place. Of these 5 went straight to PEG feeding. The 38 bridle patients received 308 days of NGT feeding (median 7 range 1–32). Of these only two required long-term PEG feeding and 21 were able to have their bridles removed as they were no longer required. Fifteen patients with bridles died for reasons unrelated to their bridle. An additional 147 chest x-rays had been used prior to referral while only one additional x-ray was required to confirm NGT position after bridle placement. Conclusion Bridle fixation reduces the number of NGT re-insertions, inappropriate PEG tubes and helps to prevent delay of nutrition restoration. They also reduce repeated radiation exposure from recurrent x-rays and overall hospital costs. Bridles have a very low incidence of complication and help reduce unnecessary PEG insertions in high-risk groups if patients are assessed carefully by trained staff.

M1407: Transpyloric Feeding (TP) Tube Promotes Closure of Refractory, Non-Healing Gastrocutaneous (GC) Fistulae Following Removal of Percutaneous Endoscopic Gastrostomy (PEG) Tube

Gastrocutaneous fistula commonly develop following removal of PEG feeding tubes. However, healing and closure of the fistula occurs in most cases. Rarely, persistent leakage is a sign of non-healing or refractory gastrocutaneous fistula. Several operative techniques have been utilized to achieve healing of GC fistula. These include surgical closure or endoscopic approaches as fibrin glue, endoclipping, laser, electrochemical cautery etc.

PTH-055 Efficacy of nasal bridles in preventing nasogastric tube displacement. The Royal Berkshire experience

<h3>Introduction</h3> Rates of accidental removal of nasogastric feeding tubes (NGT) within hospital can reach up to 60% which exposes patients to risk from repeat procedures as well as consuming resources. Nasal bridles are not routinely used in the UK despite demonstrating a reduction in NGT removal rates, reducing the occurrence of unnecessary percutaneous gastrostomy (PEG) placements and increasing nutrition delivery. At the Royal Berkshire Hospital patients are deemed suitable for bridle placement if three or more NGT have been removed unintentionally, there is no history of nasal trauma and not so confused as to risk causing themselves nasal septal injury. All patients are assessed by a clinical nurse specialist. It is Trust policy to confirm all NGT placements with a chest x-ray. We audited our practice to assess whether bridles are effective and safe. <h3>Methods</h3> Database records for all patients referred for NG bridles between June 2007 and September 2009 were reviewed. Where additional information was required, case notes were obtained. Radiology exposure was also assessed. <h3>Results</h3> fifty-one patients were referred for bridle placement during the 27-month audit period. Median age was 72 years (range 36–90). Cerebrovascular accident was the most common reason for referral (82%). All patients had had at least 3 NGT placed prior to referral (median 3 range 3–8). 38 of the 51 patients (74.5%) had bridles attached using 39 devices in total. One patient required bridle replacement and only one experienced significant nasal trauma. The reasons for not placing a bridle included; 2 were too unwell, 6 were already eating, 3 refused and 2 were too difficult to place. Of these 5 went straight to PEG feeding. The 38 bridle patients received 308 days of NGT feeding (median 7 range 1–32). Of these only two required long-term PEG feeding and 21 were able to have their bridles removed as they were no longer required. Fifteen patients with bridles died for reasons unrelated to their bridle. An additional 147 chest x-rays had been used prior to referral while only one additional x-ray was required to confirm NGT position after bridle placement. <h3>Conclusion</h3> Bridle fixation reduces the number of NGT re-insertions, inappropriate PEG tubes and helps to prevent delay of nutrition restoration. They also reduce repeated radiation exposure from recurrent x-rays and overall hospital costs. Bridles have a very low incidence of complication and help reduce unnecessary PEG insertions in high-risk groups if patients are assessed carefully by trained staff.

Nasal bridling decreases feeding tube dislodgment and may increase caloric intake in the surgical intensive care unit: A randomized, controlled trial*

To determine whether nasal bridling is a low-morbidity practice that decreases feeding tube dislodgment and results in improved caloric intake. Randomized, controlled trial. Private, tertiary-care referral center. A total of 80 surgical intensive care unit patients requiring nasojejunal feeding. Nasal bridling of feeding tubes. Between January 1, 2008 and July 31, 2008, 80 patients were randomized to have their nasojejunal feeding tubes secured with either a nasal bridle or an adhesive device. Baseline characteristics examined included age, sex, concurrent nasogastric tube presence, primary diagnosis, Acute Physiology and Chronic Health Evaluation III score, need for mechanical ventilation, need for emergent surgery, Riker Sedation Score, and Glascow Coma Scale. Patients were monitored daily for prevalence and cause of feeding tube removal, percentage of goal calories received, nasal ulceration, and sinusitis. Serum albumin and prealbumin levels were collected weekly. All patients were examined, using an intention-to-treat design. Except for a higher prevalence of emergent surgery in the bridled patients, the bridled and unbridled groups had no difference in baseline characteristics. Bridled tubes were less likely to be unintentionally dislodged than unbridled tubes (18% vs. 63%, p < .0001) resulting in bridled patients receiving a higher percentage of goal calories (median 78% [interquartile range, 65%-86%] vs. 62% [interquartile range, 47%-80%], p = .016) than unbridled patients. There were five cases of mild epistaxis upon bridle insertion and four cases of superficial nasal ulceration associated with the bridle. No bridled patients were diagnosed with sinusitis during the study period. Serum albumin and prealbumin levels did not differ between the groups. Bridling of nasoenteric feeding tubes in critically ill patients is a low-morbidity practice that reduces the rate of unintentional tube dislodgment and may result in improved caloric intake.