Bedside Feeding Tube & Bridle Placement

Nutrition Update: Together Toward Tomorrow

Intermountain clinical nutrition September 17-18, 2015

Objectives • Identify patients and conditions appropriate for

feeding tube bridle placement. • Understand basic steps of feeding tube bridle

placement. • Understand basic strategies for unclogging feeding

tubes and for preventing feeding tube clogs. • Understand basic steps of bedside feeding tube

placement.

Why?

Dietitian Pros & Cons • Better understanding of patient experience • Increased empathy • Ability to trouble shoot feeding tube problems • Recognition from RNs and other staff • Improved relationship with caregiver team • Marketable skill • Avoid burn out

Dietitian Pros & Cons • Exposure to mucous and vomit • Inflict pain or discomfort • Difficult or agitated patients • Increased responsibility/liability • Greater commitment

http://www.youtube.com/watch?v=zpHLNPsUY9c#t=2m25s

Data collection Training Equipment Support Idea

Getting there

Support

• Direct manager • Fellow staff • Nursing • Physicians • Administration • Approving committees • Outside sources

Equipment

Feeding tube bridle

Dobhoff Feeding Tube

OUCH!

Frederick-Miller Feeding Tube

Tiny!

Cortrak

Other Tubes

Other Tubes

http://www.covidien.com/KangarooIRIS/pages.aspx

Personal Protective Equipment: a fashion must

Personal Protective Equipment: a fashion must

Stethoscope

Training: Bridle Placement

• MD champion • Watch one – Do one • Competency check list provided by

manufacturer

Bridle Placement Method • Insert probes • Feel & listen for click • Remove stylet • Pull tape through • Clip onto feeding tube • Knot and clip ends

Bridle Equipment

Insert Probes

Listen & Feel for Click

Remove Stylet

Pull Through

Clip onto Feeding Tube

Knot and Clip Ends

Communication

Training: Bedside Feeding Tube Placement

• Outside advice • Create training competency • One on one training with multiple RNs • Trained RDs pass off other RDs

Feeding Tube Placement Method

• Position patient • Measure • Advance to stomach • Assess

o Pull back with syringe o Watch for “pop” o Observe contents for amount, texture, color o Listen over abdomen middle and side

• Advance using “puff and twist” • Assess again, look for changes • Secure • Confirm placement (abdominal film) • Document

Feeding Tube Placement Equipment

Measure

Position

Advance

Assess

Puff and Twist

Secure

Gastric Placement

Advanced to Jejunum

Gastric Placement

Advanced . . . to Stomach

Coiled in Stomach

Coiled in Hiatal Hernia

Duodenal Bulb

2nd Portion duodenum

Ligament of Treitz

Jejunum

In the Lung

Gastrograffin in the Lung

YIKES!

Feeding tube clogs

Evaluate o Ask questions o Look at KUB o Evaluate tube o Is it kinked?

Feeding tube clogs

Equipment o Chux, gown, gloves, ponytail holder o Syringes, Various sizes/tips o Graduated cylinder, cups o Leur adapter o HOT water o Coke? o Epidural catheter? o Enzymes?

Feeding tube clogs

Prevent! o Educate o Proper medication administration o Flushes o Never stop feeding with out flushing

Clear feeding tube

Feeding tube clog

Feeding tube sludge

Data collection • Checklist items • Adverse events • RD time spent • Time from order to insertion • Gastric vs SB placement • Who placed the tube

Thank you!