Reining in Nasogastric Tubes: Implementation of a Pediatric Bridle Program

Area of Science:

• Pediatric Gastroenterology
• Clinical Nutrition
• Medical Device Securement

Background:

• Medically complex children (MCC) often require nasogastric (NG) tubes for enteral nutrition, but frequent inadvertent dislodgement necessitates replacements.
• Existing NG tube securement methods are not optimized for pediatric use, and nutritional management for MCC can be fragmented across disciplines.
• Nasogastric tube (NG) bridles, effective in adults, are underutilized in pediatric settings.

Purpose of the Study:

• To establish a pediatric NG bridle program to enhance securement and improve nutritional support for MCC.
• To bridge interdisciplinary gaps in the care of MCC requiring NG tubes.
• To reduce NG tube dislodgement and associated complications.

Main Methods:

• A multidisciplinary work group (nurses, physicians, dietitians, APP, SLP) developed referral criteria, policies, and order sets for NG bridles in May 2018.
• Formal training sessions were conducted for clinicians and administrators.
• Patient enrollment criteria, competency modules, and ongoing patient status reviews were implemented.

Main Results:

• The program successfully enrolled 244 patients since May 2018, adhering to strict enrollment criteria.
• Successful implementation of the NG Bridle program was achieved.
• Continuous monitoring of relevant outcomes for process improvement is ongoing.

Conclusions:

• The pediatric NG bridle program effectively addressed the challenge of NG tube dislodgement in MCC.
• The multidisciplinary approach facilitated successful program implementation and improved patient care.
• Ongoing monitoring will assess long-term outcomes and potential downstream effects.