Objectives: To establish the most effective securing devices and techniques for preventing
nasogastric tube displacement or inadvertent extubation, mucosa and skin lesions,
discomfort, and complications (ab ingestis pneumonia, reduced caloric intake, mortality)
in adult patients.
Design: Systematic review of published and unpublished reports in any language,
identified by searching 5 electronic databases, websites, reference lists, and existing
systematic reviews and papers identified by experts in the field.
Eligibility criteria for selecting studies: Systematic reviews, randomised controlled trials,
and comparative studies that compared 2 techniques or devices to secure nasogastric
tubes in patients 18 years old or older.
Results: Five studies (of which two were randomised controlled trials) were included. Four
studies reported on bridle versus the tape technique (unbridled). The studies’ population
was comprised of mostly Intensive Care Unit patients. Four studies measured
unintentional dislodgement or removal and found a statistically significant advantage
in favour of the bridle. Three studies measured time until failure: two studies compared
the bridle versus tape technique whereas the other compared different types of tape. One
study did not find any significant difference between the two groups of patients whereas
the second demonstrated a significantly longer time until failure in the bridled patients.
Three studies comparing bridled and unbridled patients measured adverse events such
as external nasal ulceration, epistaxis and sinusitis, and there was no agreement between
their results.
One study measured caloric intake and found that bridled patients received a higher
percentage of their caloric goal than unbridled patients.
Only one study analysed the cost-effectiveness of the bridle versus the tape technique
and found a cost saving by implementing routine bridling of nasoenteric feeding tubes.
Discomfort was not measured in the included studies.
Conclusions: Despite the large number of patients receiving this intervention, there is
insufficient evidence to suggest one securing technique or device over another. Data are
lacking on the beneficial effects of the various methods or systems. There is little or no
statistically significant evidence regarding bridling of nasogastric tubes but more research is
needed. There is a need for more well-designed studies conducted in various clinical settings.