Background/Aims
Nasoenteric tube (NET) dislodgement is common in dysphagic stroke patients, impeding nutritional adequacy, consuming health resources and worsening patient experience. Nasal bridle devices aim to reduce dislodgement risk, but the impact of routine use in acute stroke has not been systematically assessed. We aimed to determine whether routine nasal bridle use reduces dislodgements and the impact of dislodgement.
Methods
We performed a pre- and post-intervention cohort study in a single-centre tertiary stroke unit from July 2021 to August 2022. Following a 6-month baseline period, and staff training, patients receiving NETs routinely also received nasal bridles. The primary outcome was NET dislodgement, assessed using adjusted repeated measures generalised linear models. Secondary outcomes included nutritional adequacy.
Results
In the two groups (70 patients' pre-intervention and 49 post), baseline age (78 years (interquartile range (IQR) 70-84) vs 79 (73-86)) and stroke severity (NIHSS 13 (IQR 8-21) vs 14 (10-21)) did not differ. Post-intervention the odds of removal were not significantly lower in either intention to treat (0.64 (95% confidence interval (CI) 0.37-1.10) or per-protocol (0.66 (0.35-1.23) cohorts, however the number of removals (1.7 vs 1.1 (risk ratio 0.53 (95% CI 0.35-0.79) appeared lower in the per-protocol cohort. Mean nutritional adequacy was higher in intention to treat (77.0% vs 92.3%, adjusted difference 10.0% (95% CI 1.4-18.9%)) and per-protocol (84.2% vs 96.9% (adjusted difference 10.6% (95%CI 5.8-15.8%)) cohorts.
Conclusion
Routine nasal bridle insertions following stroke may reduce the incidence of NET dislodgement and improve nutritional adequacy.