Having a bridled fine bore feeding tube

What is a fine bore feeding tube

A fine bore feeding tube is a long, soft, thin tube, which is passed through a nostril, down the back of your nose and throat, into your stomach or intestine (usually so that nutrition, fluids and/or medications can be given without you having to chew or swallow).

What is a nasal bridle?

A nasal bridle is a fixation device used to hold the feeding tube in place. It is made of silicone tubing and a plastic clip. A Nutrition Nurse Specialist or other trained professional, can place the bridle without sedation at the bedside. The Bridle device can remain in place for 30 days of continuous use.

Why do I need nasal bridle to secure my feeding tube?

Bridles are not required for all feeding tubes but maybe necessary if your feeding tube have been prematurely pulled out several times or you are sensitive to adhesive dressing used to secure the feeding tube.

A nasal bridle supports your nutritional outcomes as it reduces delays due to premature removal or accidental displacements. Securing the tube in place with a bridle can help prevent this.

The Nutrition Nurse will complete a risk assessment to ensure a bridle is appropriate.

How is a nasal bridle inserted?

The nasal bridle is placed by passing a silicone tubing into one nostril, which passes around the bone at the back of the nose (the Vomer bone) using small magnets attached to the end of the tube. The silicone tubing comes out through the other nostril using a probe in the opposite nostril.

The feeding tube is then secured to the silicone tubing using the clip. Inserting the nasal bridle is a short procedure but it may be briefly uncomfortable but this would settle.

There are occasions when it may be difficult or not be possible to place the bridle.

How does a nasal bridle work?

If the bridle was placed to prevent premature removal once the nasal bridle is in place, you will not be able to pull out your feeding tube (unless pull very hard).

If the feeding tube is pulled it will cause some discomfort over the Vomer bone and this discomfort will discourage pulling on the tube.

If the feeding tube is pulled very hard, it will stretch and pull through the bridle.

What are the risks / complications of the procedure and having a bridled feeding tube in place?

• If there is a previous history of damage or surgery to the nose, it may not be possible to place a bridle.
• If the feeding tube continues to be pulled consistently, under some circumstances even the bridle will not hold it in place
• A serious risk of NG feeding is feed inadvertently going into the lungs. The position of the NG tube will be checked when it is first passed and each time the tube is going to be used.
• If you cough violently or vomit, the NG tube can occasionally move out of place so it may not be safe to secure the feeding tube with a bridle.

How to care for your nasal bridle

The nasal bridle will need to be checked and cleaned on a daily basis

1. Clean the clip and silicone tubing daily with water and a cloth or gauze.
2. Check the clip for any signs of damage and make sure the knot is tight.
3. Check the markings on the feeding tube next to the clip before every use to make sure the tube has not slipped. This can happen if the feeding tube is pulled hard or if the clip is worn.
4. If the feeding tube is secured to your cheek to stop it dangling, it is important to make sure that the tube and bridle are not pulled tightly to one side. This can cause pressure damage to the soft tissue of the nose, the area between the nostrils (the columella) and the nasal flares.
5. Observe for signs of pressure sores or erosion, swelling or secretions which will require attention from a nurse or doctor.

How long will the bridled tube stay in place?

• A bridled tube is usually a short-term measure to ensure that tube feeding is not interrupted by frequent tube dislodgements but can be used as long as it is clinically appropriate.
• Once tube feeding or oral feeding can continue safely without the bridle, it is simple to remove by nursing staff. The silicone tube is cut on one side and gently withdrawn from the nostril

Can you be discharged with a bridle?

• If you have a bridled tube in place and community based care is to be considered for any length of time, your medical team is advised to refer you to the Feeding Issues Multidisciplinary Team for advice on the best feeding route for you.
• If tube feeding is likely to be required long-term then a gastrostomy tube (PEG) may be considered. Your medical team will discuss if this is appropriate for you.

Can the feeding tube be changed with a nasal bridle?

Yes, the feeding tube can be replaced without the need to change the bridle. The plastic clip on the bridle is opened using a plectrum, so that the feeding tube can be removed. Once the new tube is in place, the clip is then re -attached.

Removing the nasal bridle and feeding tube

If the nasal bridle and feeding tube both need to removed, then one strand of the silicone tube is cut between the nostril and the clip, and both the bridle and feeding tube are removed together.

Removal of the nasal bridle only

If you no longer require the bridle but will continue to use a feeding tube, the bridle can be removed. The plastic clip is open to release the feeding tube then one strand of the silicone tubing is cut to gently withdraw the bridle only from the nostril.

Further Information

If you have any questions, please contact the Nutrition Nurses on 01223 216037 (Option 1)