OasisLMS

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Megan S. Foster

Introduction/Hypothesis: Nasoenteric feeding tubes are commonly used in pediatrics as a way to deliver nutrition and medications. Traditionally, these tubes have been secured with adhesive tape to the face. However, unintentional tube dislodgement continues to be a common occurrence. Tube dislodgement leads to multiple tube replacements which causes discomfort and additional radiation exposure; delays in nutrition and medication administration; and increased consumption of hospital resources between the cost of replacement tubes, radiographs, and staff hours spent on these procedures.

Methods: This is a prospective, open-label, randomized control trial comparing the routine adhesive tape to the FDA approved AMT® BridlePro as a mode for securement of nasoenteric feeding tubes. The study population included pediatric patients admitted to our inpatient areas who required a nasoenteric feeding tube. Our power analysis based on Fisher's Exact test recommended 30 patients be randomized to the control (tape) arm and 30 patients to the nasal bridle arm. The primary outcome was to assess the clinical efficacy of the nasal bridle system by the incidence of tube dislodgement. Secondary outcomes included time to tube dislodgement, minutes of missed nutrition, amount of additional radiation exposure, and cost of additional feeding tubes and radiographs. Adverse events including skin breakdown, discomfort, or other injury were also evaluated.

Results: Preliminary data after 30 patients suggests use of the AMT® nasal bridle reduces attributable risk for feeding tube dislodgement by 60%, p<0.001. In log rank analysis, tubes secured with tape had 2.11 dislodgements per 100 tube days compared to 0.16 for tubes secured with the bridle, p<0.001. Additionally, tubes secured with tape had a faster time to tube dislodgment and larger amount of missed nutrition.

Conclusions: Securing nasoenteric feeding tubes with the AMT® nasal bridle system significantly reduced tube dislodgements. Preliminary data supports that the AMT® nasal bridle system may be a safe and effective method to ensure consistent delivery of nutrition and medications to hospitalized children.