The knock-on effect of reduced NGTs and x-rays is also a reduction of work for the portable radiography team, in what is a very time- and resource-consuming process of coming onto the COVID-19 CCU. Not only does the machine itself need to be wiped down thoroughly after use, but also the individual must use personal protective equipment (PPE) each time. There is a cost associated with PPE itself, as well as the time it takes to don and doff appropriately.
A reduction in chest radiographs reduces the irradiation of the patient and the potential irradiation of staff members. With bridling of the NGT, the radiation exposure is more than halved for the patient. Because the COVID ICU is often very busy, with patients in some cases being doubled up in a bed space, the scatter radiation is high. This can be reduced if fewer chest radiographs are required.
An additional benefit of a reduction in the mean number of NGT insertions per patient is also illustrated by anecdotal evidence. Over the studied period, we identified 2 traumatic pneumothoraces related to NGT insertion on the COVID-19 CCU, highlighting the potential risks of NGT insertion and the need to reduce its frequency, if possible.
One concern noted was that bridles could cause increased incidence of pressure sores. In the patients represented in this study, only 1 suffered a pressure sore (grade 2) directly related to the bridle. A subpopulation of patients not bridled was also noted. This was significantly smaller than the main group; however, we had noted 2 incidences of pressure sores from their standard NGT and securement devices. Some studies have alluded to the potential for increased skin complications with bridle kits; however, studies looking specifically at kits using umbilical tape (as in this study) show no significant increase in skin damage.10 This leaves us confident that there is no increased risk of pressure sores related to the bridling of patients when umbilical tape is used with the bridle kit.
NGT bridles require training to insert safely. With the introduction of bridling, our hospital’s nursing staff underwent training in order to be proficient with the bridle kits. This comes with a time commitment, and, like other equipment usage, it takes time to build confidence. However, in this study, there were no concerns raised from nursing staff regarding difficulty of insertion or the time taken to do so.