`

`The development of a nasopharyngeal sling for anchoring
`termed the bridle by Luther and Armstrong, 10 has al(cid:173)
`nasoenteric nutritional support to be used with less
`of tube displacement. The bridle has increased the
`of patients managed through the enteral route.
`TECHNIQUE
`The technique was first described in 1981.10 Since that time,
`i(we have used it with slight modifications. A minimal amount
`~ofequipment(an 18" length of small base silicone rubbertub(cid:173)
`::;ing, a' McGill or ~imilar forceps, and 00 silk suture) is neces:
`fsary to create the bridle (Figure 1 ).
`.
`After a thorough explanation of the procedure, the patient
`is allowed to sit up or the head of the bed is raised to 45°. The
`t nostrils are checked for patency to establish which to use for
`.,:inserting the feeding tube. Both nostrils are lubricated with
`topical anesthetic. The hypopharynx is sprayed with a top(cid:173)
`ical anesthetic to decrease gagging. One end of the silicone
`rubber tube is placed in one nostril gently pushing the tube
`tip down and back. The other end of the tube is placed in the
`'opposite nasal passage in the same manner (Figure 2). When
`each limb has been advanced approximately 8", the patient
`js asked to open his mouth. Both ends of the tubing should
`••.• be visible in the hypopharynx. The two free ends are grasped
`with the forceps, pulled out through the mouth (Figure 3),
`and sutured together (Figure 4). The loop of tubing across the
`columella is then pulled gently, bringing the tied ends of the
`
`tube back to the nasopharynx and eventually to the posterior
`aspect of the nasal septum (Figure 5). One side of the loop is
`then advanced through one nasal passage while the other side
`is pulled, bringing the sutured ends through the nasal passage
`(Figure 6). Next, the tied ends are cut and the tubing is tied
`to itself allowing enough room between the loop and the sep(cid:173)
`tum to prevent pressure necrosis (Figure 7). Silk ties are placed
`in front and back of the knot to prevent slippage (Figure 8).
`The excess tubing is cut and the bridle is completed (Figure
`9).
`The enteric tube is then inserted through the preselected
`nasal passage and, once .in place, anchored to the bridle by
`silk sutures and adhesive tape (Figures 10 and 11 ). Attempts
`at pulling the tube will result in gentle traction of the posteri(cid:173)
`or aspect of the nasopharynx. Serious dislodgement by cough(cid:173)
`ing, sneezing, or gagging is usually prevented by the fixed
`point of the tube.
`
`CARE
`The bridle and tube should be checked every eight hours.
`Tube position and bridle looseness should be noted. The ten(cid:173)
`dency towards crusting can be avoided by use of topical anti(cid:173)
`biotic ointments. The adhesive tape should be replaced if
`loose or wet.
`
`RESULTS
`To date, we have employed this technique in 10 patients
`over the past year with encouraging results. The bridle has
`
`Figure 4: Ends sutured.
`
`Figure 5: Sutured ends being pulled back to hypo, and nasopharynx.
`
`Figure 6: Sutured ends brought out through a nasal passage.
`
`Figure 7: Tube tied to itself after cutting suture connecting ends.
`
`9
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`CORPAK Ex 1006, Page 2
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