Improving retention of pediatric feeding tubes with a nasal bridle: a randomized controlled trial

Nasoenteric feeding tubes are necessary in hospitalized children to deliver nutrition and medication. Traditionally, adhesive tape secures these feeding tubes but fails to prevent 40% of tube dislodgements. The nasal bridle, a thin plastic anchor placed around the vomer bone, is an increasingly used method for tube securement. Our objective is to compare AMT Bridle Pro® nasal bridle versus conventional tape to safely reduce tube dislodgement in pediatric patients.

A prospective, open-label randomized controlled trial was carried out between February 2020 and January 2021 at a tertiary pediatric hospital. Infants, children, and adolescents less than 18 years of age with an order to place a nasogastric or post-pyloric feeding tube were approached for enrollment. Exclusion criteria included facial trauma, nasal airway obstruction, or thrombocytopenia. After obtaining consent, patients were randomized to AMT Bridle Pro® nasal bridle or conventional tape to secure the feeding tube. The primary outcome was the frequency of feeding tube dislodgement, defined as unintentional tube removal or change in position. Secondary outcomes included days to feeding tube dislodgement, number of dislodgements per 10 tube days, resource use, and complications from tube securement.

A total of 35 patients were randomized and equally split to the bridle (n = 17) and tape arm (n = 18). The primary analysis revealed the rate of feeding tube dislodgement over 30 days was significantly higher in the tape group compared to the bridle group with an attributable risk reduction of 57% (hazard ratio = 6.3, 95% CI 2.4-16.5, p < 0.001). After 30 days, tubes dislodged at a proportion 88% (15) in the tape arm compared to 31% (5) in the bridle arm (risk ratio = 2.82; 95% CI: 1.34-5.96; p = 0.001). There were no serious adverse events. Four patients in the tape group developed erythema and skin breakdown where the tube was secured with tape. One patient was withdrawn from the bridle group because they developed erythema on the nasal septum after placement, which resolved quickly upon removal of the bridle.

Securing nasoenteric feeding tubes with the AMT Bridle Pro® can effectively reduce tube dislodgements in hospitalized children.

ClinicalTrials.gov NCT04621734. Registered on November 3, 2020. https://clinicaltrials.gov/search?cond=NCT04621734 .