Date of Award
Summer 2021
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Advisor
Schindler, Christine
Second Advisor
Goday, Praveen
Third Advisor
Garnier-Villarreal
Abstract
Nasogastric tubes (NGTs) are commonly placed in children at risk for malnutrition in order to provide temporary nutrition support until the child achieves independent oral feedings or requires durable tube placement. Accurate securement of NGTs is necessary to safely provide nutrition, particularly in infants and toddlers who are at highest risk for dislodging their NGT. Dislodgement of an NGT has a cascade effect on the medical management, requiring increased exposure to the healthcare system with every replacement. Nasal bridles are widely used to secure NGTs in adults but are not widely used with children. The purpose of this retrospective, correlational study is to compare NGT-related outcomes for children with standard tape securement of an NGT with those that have had a nasal bridle to secure the NGT.Lewin’s Theory of Planned Change provides a framework to motivate the adoption of new medical techniques. Lewin’s theory posits several components: analysis of environment components that both push change forward and prevent change from occurring; preparing stakeholders for change to come; the period of actual change; and achieving sustainable change. This framework was used to implement a nasal bridle program across one pediatric tertiary medical center. The bridle program was implemented incrementally across departments through institutional credentialing of providers, education of nurses, and instruction for families. Patient outcomes, both with and without bridle placement, were tracked via the electronic health record at the time of NGT placement until the child achieved full oral feeds or obtained a durable tube. Outcomes of Interest included NGT dislodgements, length of stay, number of unplanned clinical encounters, radiographic exposure, adverse skin outcomes, and transition to oral feeding versus placement of a durable tube for ongoing nutrition support. Results/Conclusions: Between March 2018-August 2020, 582 children received NGTs secured traditionally (with facial tape) and 173 received nasal bridles to secure the tube in place. The mean initial hospital length of stay post placement of the NGT was 28 days in the bridle group and 54 in the standard care group (p<0.001). Bridled NGT children were 1.49 times less likely to have one more unplanned medical encounter than their non-bridled NGT counterpart (OR=0.67, 95% CI 0.40, 1.14). Dislodgements were more frequent in the unbridled NGT group compared to the bridled NGT group, respectively (M=4.73, 0.33; p<0.001). Within this cohort, 62.4% (n=108/173) children with bridled NGTs and 77.1% (449/582) children with unbridled NGTs progressed on to achieve sustained oral feedings and required no further therapy. Children with a bridled NGT were 4.76 times less likely to require one more radiographic exposure than an unbridled child (OR=0.21, 95% CI 0.14, 0.33). Adverse skin outcomes were rare in both groups.