How do you advance a Dobhoff tube?

How do I check my Dobhoff placement?

Radiographically, a correctly positioned tube should pass vertically midline below the level of the carina, it should not enter the right or left bronchi, and the tip of the tube should be visible below the level of the diaphragm. The use of Dobhoff tubes are not without complications.

Can you aspirate a Dobhoff tube?

Dysphagia and aspiration

These patients will require a secondary mean of nutrition (percutaneous endoscopic gastrostomy [PEG] tube, nasogastric [NG] tube, gastrostomy-jejunostomy tube, or Dobhoff tube), although placement of a feeding tube may not remove all of the risk of aspiration.

How do you advance NGT?

Gently insert the NG tube along the floor of the nose, and advance it parallel to the nasal floor (ie, directly perpendicular to the patient’s head, not angled up into the nose) until it reaches the back of the nasopharynx, where resistance will be met (10-20 cm).

Can a Dobhoff cause a pneumothorax?

Due to blind placement, Dobhoff tubes may be inadvertently positioned within the lung via the tracheobronchial tree, resulting in pneumothorax or hemothorax. This case report contributes to the literature by describing another rare instance of hemothorax from traumatic Dobhoff misplacement.

How do you confirm a feeding tube placement?

To Check NG Tube Placement

  1. Attach an empty syringe to the NG tube and gently flush with air to clear the tube. Then pull back on the plunger to withdraw stomach contents.
  2. Empty the stomach contents on to all three squares on the pH testing paper and compare the colors with the label on the container.

How far should Dobhoff be placed?

Recommend advancing 5-8 cm to insure the tip is within the stomach. e) Tip or sidehole beyond the pylorus with a distended stomach. Dobhoff feeding tube: A tube placed to one of three levels for delivery of nutritional feedings and medicine.

How do you give medicine through Dobhoff?

Quote from Youtube:
Attach the syringe to the end of the feeding tube and push the plunger down to administer the medication. Flush the tube with at least half an ounce of water after giving the medication.

What type of feeding tube is a Dobhoff?

Dobhoff tube is a special type of nasogastric tube (NGT), which is a small-bore and flexible so it is more comfortable for the patient than the usual NGT.

How often do you verify feeding tube placement?

The position of the tube must be checked:

  1. Prior to each feed.
  2. Before each medication.
  3. Before putting anything down the tube.
  4. If the child has vomited.
  5. 4 hourly if receiving continuous feeds.

How much residual is too much?

If the gastric residual is more than 200 ml, delay the feeding. Wait 30 – 60 minutes and do the residual check again. If the residuals continue to be high (more than 200 ml) and feeding cannot be given, call your healthcare provider for instructions.

How do you place a Dobhoff bridle?

Quote from Youtube:
Begin the procedure by inserting the probe into the nostril opposite of the nasal tube along the floor of the nostril. Do not insert upwards towards the patient's.

What is the maximum hanging time for an open system tube feeding?

Higher degrees of contamination have been found in reconstituted powdered formulas and in open systems allowed to hang for extended periods of time (greater than 21 hours).

When do you stop tube feeding residuals?

Typically, standard nursing practice is to stop tube feedings due to gastric residual volume (GRV) that is twice the flow rate. So, a feeding rate of only 40 mL per hour would be held with a measured GRV of 80 mL.

How do you know if NGT is in the lungs?

Locating the tip of the tube after passing the diaphragm in the midline and checking the length to support the tube present in the stomach are methods to confirm correct tube placement. Any deviation at the level of carina may be an indication of inadvertent placement into the lungs through the right or left bronchus.

What happens if NGT in lungs?

The tube may enter the lungs Because of the proximity of the larynx to the oesophagus, the nasogastric tube may enter the larynx and trachea (Lo et al, 2008). This may cause a pneumothorax (Zausig et al, 2008). When the tube is in the airway, it will cause severe irritation and cough.

Can you puncture a lung with a feeding tube?

Endotracheal misdirection of narrow bore nasogastric feeding tubes resulted in perforation of the lung, pneumothorax and hydrothorax in two intensive care patients.

Can a feeding tube cause a pneumothorax?

The indications for insertion of nasogastric feeding tubes are many and the procedure is considered harmless; however, if the tube is misplaced there is good reason to be cautious on removal as this can unmask puncture of the pleura eliciting pneumothorax and, as this case report shows, result in an ultimately deadly

What is one of the most common health complications related to feeding tube usage?

Complications Associated with Feeding Tube

  • Constipation.
  • Dehydration.
  • Diarrhea.
  • Skin Issues (around the site of your tube)
  • Unintentional tears in your intestines (perforation)
  • Infection in your abdomen (peritonitis)
  • Problems with the feeding tube such as blockages (obstruction) and involuntary movement (displacement)

Can NGT cause aspiration pneumonia?

NGT feeding is known to be a significant cause of aspiration pneumonia in stroke patients 10. Since the NGT bypasses the small amount of gastric contents through to the oropharynx, the materials can be easily aspirated into lower airways in dysphagic patients with stroke.

What is the best position to prevent aspiration?

Body positions that minimize aspiration include the reclining position, chin down, head rotation, side inclination, the recumbent position, and combinations of these. Patients with severe dysphagia often use a 30° reclining position.

How do you prevent aspiration when feeding?


  1. Sit the person upright in a chair; if confined to bed, elevate the backrest to a 90-degree angle.
  2. Implement postural changes that improve swallowing. …
  3. Adjust rate of feeding and size of bites to the person’s tolerance; avoid rushed or forced feeding.

What color is gastric aspirate?

You’ll find that gastric aspirate is usually cloudy and green, tan or off-white, or brown. Intestinal aspirate is generally clear and yellow to bile colored. Pleural fluid is pale yellow and serous; tracheobronchial secretions are usually tan or off-white mucus.

What is a whoosh test?

The whoosh test is undertaken by rapidly injecting air down an NGT while auscultating over the epigastrium. Gurgling is indicative of air entering the stomach, whilst its absence suggests the tip of the NGT is elsewhere (lung, oesophagus, pharynx, and so on).

Do you discard gastric residual?

To return or discard gastric residual volume is an important question that warrants discrete verification. Gastric residues may increase the risk of tube blockage and infection, whereas discarding gastric residues may increase the risk of fluid and electrolyte imbalance in patients [21, 22].

Do you flush NG tube before feeding?

Flushing instructions:

Always flush at least twice a day and before, between, and after giving medications through the NG tube. least 20 to 30 mL between each medication). every 4 to 6 hours.

What happens if you dont flush feeding tube?

Blocked tube.

A blocked tube can happen when the tube isn’t flushed or when formula or medicines are too thick. Prevent blockage by flushing the tube with warm water before and after feedings and medicines. If the tube is blocked, try to clear it by flushing the tube. Call your doctor if the tube won’t clear.

Why do we aspirate NG tube?

A nasogastric tube is a narrow-bore tube passed into the stomach via the nose. It is used for short- or medium-term nutritional support, and also for aspiration of stomach contents – eg, for decompression of intestinal obstruction.