Bedside Feeding Tube & Bridle Placement Nutrition Update: Together Toward Tomorrow Intermountain clinical nutrition September 17-18, 2015
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
Support
• Direct manager • Fellow staff • Nursing • Physicians • Administration • Approving committees • Outside sources
Other Tubes
Other Tubes
http://www.covidien.com/KangarooIRIS/pages.aspx
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
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 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
Data collection • Checklist items • Adverse events • RD time spent • Time from order to insertion • Gastric vs SB placement • Who placed the tube