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20180129

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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Gastrointestinal

Nasal Bridles: Use, Maintenance and Removal (Adult and Pediatric) (2.24AP)

Nasal Bridles: Use, Maintenance and Removal (Adult and Pediatric) (2.24AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Gastrointestinal

2.24AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
January 26, 2018

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 2.24AP

Original
Revision

Page
1
of 3

Title: Nasal Bridles: Use, Maintenance
and Removal Application (Adult &
Pediatric)


I. PURPOSE

To provide guidance on the use of a securement device (bridle) for prevention of
unintended removal of small bore nasoenteral feeding tube (8 or 10 French).

II. BACKGROUND
The bridle uses two magnetic catheters to place a twill tape bridle through one nare
around the nasal septum, and out the other nare. The twill tape is then attached to the
nasoenteral feeding tube with a small clip just external to the naris.

III. POLICY

A. Indications for use: The nasal bridle can be used in adult and pediatric patients
who are at risk for accidental displacement and/or dislodgement of small bore
nasoenteral feeding tubes. A patent airway is necessary on both sides of the nasal
septum to allow bridle insertion.
B. Contraindications:
1. Mechanical obstructions in nasal airway
2. Nasal and/or facial fractures
3. Anterior and/or basilar cranial fractures
4. INR >2.5
5. Platelets <35 K/µL
C. Educational requirement: The Registered Nurse (RN) who places the nasal bridle
must have documented educational training. Only trained individuals may insert
or adjust the nasal bridle.
D. A provider order is required for nasal bridle. Page 7777 (Feeding Tube Team) for
placement.

IV. PROCEDURE

A. Patient Assessment and Care
1. Assess facial skin for signs of pressure, irritation, and/or breakdown
related to the nasoenteral feeding tube and bridle every eight hours or
more frequently, based on individualized need.
a. Assess twill tape and bridle clip every eight hours for positioning
in the naris and integrity of the device.

Page 2 of 3

b. Call the feeding tube team to adjust/replace the twill tape if the
tape is very soiled or the tape has stretched and the clip is resting
on the upper lip.
c. If clip becomes unclamped or is non-functional, temporarily secure
the twill tape and nasoenteral feeding tube with adhesive tape and
page feeding tube team to replace clip.
2. RN may discontinue a nasal bridle.
a. When removing the nasal bridle and nasoenteral feeding tube, cut
one side of the twill tape above the knot (see Figure 1 below).
Slide the remaining twill tape out of the nose together with the
nasoenteral feeding tube.
b. If bridle needs to be removed and the nasoenteral feeding tube is to
remain in place, contact feeding tube team on pager 7777 as
removal device may need to be used.

Figure 1:





From www.amtinnovation.com/bridle.html. (Used with permission)

V. UW HEALTH CROSS REFERENCES

A. UW Health Clinical Policy 2.3.6, Small-bore Nasoenteric (Dobhoff) Tube
Placement
B. Nursing Skills Checklist for Feeding Tube Placement and Securement


VI. REFERENCES

A. Applied Medical Technology. AMT Bridle™ Frequently Asked Questions.
https://www.appliedmedical.net/gi-products/bridle/
B. Gunn SR, Early BJ, Zenati MS, Ochoa JB. Use of a Nasal Bridle Prevents
Accidental Nasoenteral Feeding Tube Removal. JPEN J of Parenteral and Enteral
Cut here to remove both
the nasoenteral feeding
tube and the nasal bridle.
Bridle Clip
Nasal Bridle
Nasoenteral
feeding tube

Page 3 of 3

Nutrition 2009; 33(1):50-54.
C. Bechtold, Matthew L., MD, et al., Nasal Bridles for Securing Nasenteric Tubes: A
Meta-Analysis. NCP Nutrition in Clinical Practice. 2014:29(5) 667-671.

VII. REVIEWED BY

Nurse Specialist, AFCH
Nursing Education Specialist, SOS
Nurse Manager, Venous Access Team & SOS Team
Feeding Tube Team
Nursing Patient Care Policy and Procedure Committee, January 2018

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive