Mrs Emma Sierp1, Mrs Jennifer Cranefield1, Ms Thu-Lan Kelly2, Mrs Natasha Reid1, Dr Lee-Anne Chapple1,3, Prof Timothy Kleinig1
1Royal Adelaide Hospital, Adelaide, Australia, 2University of South Australia, Adelaide, Australia, 3The University of Adelaide, Adelaide, Australia
Biography:
Emma Sierp is a Clinical Dietitian at the Royal Adelaide Hospital in South Australia. She has 10 years’ experience, specialising in Stroke and Neurology. Working within a collaborative MDT, Emma has initiated and completed many procedural changes and projects that have improved nutritional outcomes for Stroke and Neurology patients.
Abstract:
Background:
Nasoenteric tube (NET) dislodgement is common in dysphagic stroke patients, impeding nutritional adequacy and consuming health resources. Nasal bridle devices aim to reduce dislodgement risk, but the impact of routine use following acute stroke has not been rigorously assessed. We aimed to determine whether routine nasal bridle use reduces NET dislodgements and its negative sequelae.
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, adult patients receiving NETs routinely received a nasal bridle. The primary outcome was NET dislodgement and main secondary outcome nutritional adequacy. Generalised linear regression models adjusted for patient and stroke characteristics were used to compare outcomes pre- and post-intervention as intention to treat and per-protocol analyses.
Results:
119 patients (70 pre-intervention, 49 post-intervention) were enrolled. There were no significant baseline differences between cohorts (median age 78 (interquartile range (IQR) 70-84) vs 79 (IQR 73-86) years; and National Institute of Health Stroke Scale scores 13 (IQR 8-21) vs 14 (IQR 10-21). The number of NET dislodgements (1.7 (SD 1.6) vs 1.1 (SD 1.7) (adjusted rate ratio 0.53 (95% CI 0.35-0.79)) was lower in per-protocol analysis. Nutritional adequacy was higher in the post-intervention group, both 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%)) analyses.
Conclusion:
Routine nasal bridle insertions following stroke may reduce the frequency of NET dislodgement and improve nutritional adequacy.