NG and OG tube securement in ICU

[Tary]

Has anyone here had much experience with the bridle in intubated patients? Do they cause pressure injuries? What is the preferred feeding in intubated patients in your facility? Is it NG or OG? Are there pressure injuries with OG and NG tubes not on the bridle? 

[Okami_CCRN, BSN, RN]

We do not use a brindle securement device for NGT placement in our ICU. We typically opt for OGT and if we anticipate the patient will need enteral nutrition/medication administration we will attempt to swap out the OGT for NGT prior to extubation. 

We typically do not see much pressure injuries with OGT insertion as the tube is secured to the ETT. With NGT we swap out the securing tape every 24-48h and try to prevent the tube from touching the nostril and have it try and be centered within the nostril lumen. 

[JBMmom, MSN, NP]

Our NG tubes have a specific securement device that's just a bandaid type material shaped for the nose that has an adhesive end to wrap around the tube. Our OG tubes are usually just taped to the ET tubes, although we had a great debate a few years back where they had to be tied separately from the ET tube around the patient's head with tube gauze because they didn't want them taped to the ET tubes. 

I've seen tubes bridled a couple times, usually if it's a Dobhoff tube we expect the patient will need for a longer time. We haven't had many pressure injuries with OG or NG tubes, but they happen on occasion. 

[Tary]

Thank you both for your responses. 

[Erin Lee, BSN, RN]

I have worked with a bridle many of times, they do not typically cause pressure injuries although I have heard it is possible. Bridle's are only used to Dopoff NGTs (the teeny tiny diameter NG tubes) which are only used for enteral nutrition and medication administration. With them being so small, they tend to move around and typically don't cause pressure wounds, but I have seen them cause irritation from the rubbing, but this was on rare occasions. 

For intubation and critical care typically we use OGT, the standard larger diameter gastric tubes until extubated. These can be used for gastric decompression as well as nutrition and medication administration. 

If long-term nutrition is anticipated, then we will place a dopoff NGT with a bridle when indicated, I.e., a confused delirious patient who may accidentally snag their tube but otherwise does not need to be restrained.