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What is it? A nasal bridle is a securement method used to discourage patients, young or old, from pulling on their nasoenteric feeding tube. Reports show that 40 percent of nasogastric feeding tubes are dislodged, which may lead to the unnecessary surgical placement of a feeding device or conversion to parenteral nutrition support.* A nasal bridle is an effective and safe way to secure a patient’s nasal tube, retaining the nutrition flow to the patient.
*Seder CW, Janczy R. The Routine Bridling of Nasojejunal Tubes is Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit. NCP Nutrition in Clinical Practice. 2008-2009:23(6) 651-654
What does it look like? The nasal bridle system has several distinct pieces; a blue retrieval probe, a catheter with removable safety stylet and blue bridle tubing, a pre-attached clip, a removal tool and a lubricant packet. Most of these components serve to thread the bridle into place within the nasopharynx. Once properly inserted, only the soft bridle tubing and device clip remain. The other pieces are discarded.
The blue retrieval probe and catheter have strong rare earth magnets at their tips. The retrieval probe is inserted into the nostril without a nasal tube. The catheter with safety stylet and bridle tubing is inserted into the opposite nostril. Both the probe and stylet are advanced towards the back of the nasal septum where the two magnets will connect around the vomer bone inside the nasal cavity. The magnets allow the two pieces to unite creating the bridle loop with bridle tubing.
Once the bridle loop has been established, slide the pre-attached clip up the bridle tubing to approximately 1cm or alternatively one finger width from the nostril, and just above the lip. Then place the nasal tube into the clip’s defined nasal tube region. From here, take the loose strands of bridle tubing and place them within the clip, and close the clip. Once the clip is closed, tie the two strands of bridle catheter together into a simple knot below the clip, and cut the excess 1cm below the knot, securing the nasal tube.
The AMT Bridle™ Family has been shown to:
*Gunn SR, Early BJ, Zenati MS, Ochoa JB: Use of a Nasal Tube Bridle Prevents Accidental Nasoenteral Feeding Tube Removal. JPEN Journal of Parenteral and Enteral Nutrition 2009: 33(1): 50-54
Once the bridle tubing is passed through both nostrils and around the vomer bone, it uses the structure of the nasal cavity, specifically the vomer bone, to hold the feeding tube in place. If patients pull on the tube, they will feel a little pressure on the bone, making the bridle uncomfortable for a moment, but not painful. This deters them from continuing to pull on the tube. The goal is to secure the nasal tube in place without causing any damage.
The AMT Bridle™ Family may reduce the risk of complications from using a feeding tube without damaging the nose or causing pain to the patient. It deters pulling and also helps to prevent accidental dislodgement of the feeding tube, giving the patient more freedom to move normally.
With a device like the AMT Bridle™ or Bridle Pro®, there is no reason to tape or suture the feeding tube into place. This cost-effective AMT Bridle™ Family is barely visible and takes only about a minute to properly place. Through better tube securement the patient will experience enhanced nutrition and fewer complications like aspiration or sinusitis. Use of the AMT Bridle™ Family can dramatically reduce the occurrence of accidental tube dislodgement, avoid skin breakdown and lead to cost savings. It is a superior solution to prevent nasal tube dislodgement.
Routine bridling has become the standard of care for many ICUs due to improved nutritional outcomes and cost management. Rather than restrict bridling to suspected “problem” patients, the cost savings should result in universal use on all nasal tubes: Every Tube, Every Time!
“Based on our experience we enthusiastically encourage placement of the umbilical tape bridle via the magnet system”
• Popovich MJ, Jahan A, Sabharwal V, Walsh MR: Umbilical Tape Bridle/Magnet Placement System: A Safe, Simple Technique to Prevent The Unintentional Removal of Nasoenteric Feeding Tubes.
“The AMT Bridle novel technique offers relatively easy and quick placement without sedation.”
“We conclude that bridling of nasoenteric feeding tubes provides a safe and effective method of decreasing unintended tube dislodgement and optimizing nutritional delivery in [pediatric] patients.”
• Newton LE, Abdessalam SF, Raynor SC, Lyden ER, Cusick RA (2016) Stabilization of Nasoenteric Feeding Tubes Using Nasal Bridles In Paediatric Patients. Matern Pediatr Nutr 2:111. doi: 10.4172/2472-1182.1000111
Consistent nutrition support plays an important role in the management of nutritional deficiencies and is part of the standard of care for critically ill patients. The AMT Bridle™ system dramatically reduces feeding tube pullouts, resulting in an improved caloric intake. It is critical to maintain nasal tube securement in the neonatal and pediatric populations to ensure essential nutrition delivery to their growing bodies and avoid unnecessary nasal tube replacements. Conventional methods of tube securement using tape often lead to premature pullouts, dislodgement, and skin breakdown. For pediatric patients, AMT recommends placing the Bridle device prior to any nasal tubes.
The nasal bridle is kept in place by the strong vomer bone, which is a mid-skull bone forming part of the nasal septum. This natural structure creates the division between the two sides of the nasal cavity, establishing a natural anchor point within the body.
The vomer bone begins formation at 8 weeks’ gestation, is fully formed as a bone by 18.5 weeks’ gestation, and is ossified at birth. This allows for patients of all ages to be safely bridled with the AMT device.
Patient safety and comfort are a top priority for AMT and this cranial structure is a great securement location for nasal tubes. Once the AMT Bridle™ or Bridle Pro® is properly placed, no tape or sutures are required to keep the nasal tube secured, allowing for patients to be more comfortable.
Alternative feeding tube securement methods expose patients to potential risks, but looping one of the AMT Bridle™ systems around the vomer bone with magnetic technology provides safe securement, ultimately keeping the nutritional support intact.
There are several new elements to the Bridle Pro® system: Pro Range Clips, Pro Clips, and Blue Bridle Tubing.
The AMT Bridle™ Family is easily placed by passing magnets within the nasopharynx, which allows the bridle tubing to be looped around the vomer bone, and then anchored to the tube with a clip.
• Placed in less than a minute
• No patient sedation required
• A wide variety of French size clips to accommodate both pediatric and adult populations
• Secured without messy adhesive tape or sutures
The AMT Bridle Pro® is easily placed using magnets to draw bridle tubing through the nasopharynx; in one nare, around the vomer bone, and out the other nare, then securing it to the nasal tube with a French Size specific clip. AMT has provided this information as an educational resource. Do not attempt to use the AMT Bridle Pro® without also reviewing the product’s complete Directions for Use (DFU).
The AMT Bridle™ system consists of a retrieval probe, a flexible white catheter which houses a removable stylet guide, a pre-attached clip, a clip opening device, and a packet of water-soluble lubricant.
The AMT Bridle™ system consists of a retrieval probe, a flexible white catheter which houses a removable stylet guide, a pre-attached clip, a clip opening device, and a packet of water-soluble lubricant.
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