Dobhoff Tube Insertion

[infirmiere77]

Hello nurses!

Our hospital is currently reviewing our policy on the insertion of Dobhoff tubes (small-bore NG tubes used for feeding/meds) and I thought I would go to the best possible source for input.

At our community hospital, RNs on all units insert them and verify placement via stat KUB. However, in our review we have found that many local hospitals have changed to physician (usually resident) or advance practice nurse insertion only.

How does it go at your hospital? Who inserts dobhoff tubes? If RN, is that true of ICU RNs only or on all units (if you know)?

Thanks so much for your feedback!

Could you also tell me the name of your hospital? The info will only be used to make our case to our administrators and for our information. Feel free to send a private message if you are more comfortable.

[CharleeFoxtrot, BSN, RN]

I work in an LTAC, and they also recently changed policies that only an MD can insert DH tubes. No reason was given for the change, and it came a surprise to us on the floor. I'll message you the name as they have a strict "no talky on the interwebs" philosophy

[RNewbie]

I've always worked at hospitals were nurses insert small bore ngt. I dont see why it should matter who inserts it as long as they are trained. I did work at a facility as an agency nurse that did not do kub to confirm. After I put the dobhoff tube down I asked the charge nurse how to enter the order for the kub. She said they don't use X-ray to confirm. I pulled up the policy to read it for myself. No where did it state to verify placement with kub. I didn't feel comfortable using it, thankfully I didn't have to give the pt anything through it. Next day I was getting report from the night shift nurse (who was also agency) and she mentioned that she did not use the tube because placement had not been verified. Then I knew I was not crazy for not feeling comfortable using it. Working agency has shown me that hospitals have all kinds of different policies and they all believe that their way is best.

[PediLove2147, BSN, RN]

Only MDs place Dobhoff's and NGTs in my facility. ICU RNs may be able to I am not sure. We always confirm with a KUB.

I work in Boston.

[beckster_01, BSN, RN]

I work in a large teaching hospital. On the floors only residents/NPs insert them. In the ICU an RN can do it. An we do always verify with a KUB before using it.

[nrsang97, BSN, RN]

Only MD's in our system. I have never inserted one as a nurse.

[MomRN0913]

In my old hospital, only the nurses in the ICU could insert. And the verification was not a cxr. It was air bolus.

[Tait, MSN, RN]

Sounds like this is a great opportunity to use the best resource you have, the hospital librarians. They can research EBP articles that will be more valuable to your policy group than random online opinions.

[ChristineN, BSN, RN]

At my current hospital it must be inserted by physician only and placement must be confirmed by x-ray. Confirmation of placement is only accepted when the x-ray has been read by a radiology attending physician.

At past hospitals I would place them and no other facility I have worked at had a x-ray requirement

[applewhitern, BSN, RN]

Wow, that is strange. We (RN) inserted them all the time at every hospital I have worked at. If they keep taking away stuff the nurse used to do, pretty soon they won't need us at all! We used to intubate if the doc couldn't get it, place coudee caths, and other stuff, now I am told we can't place coudee caths anymore! Now I hear this. Oh, we used to draw our own ABG's, too; now only the lab personnel can draw them. (No, not respiratory, only the lab!

[betterlatethennever]

Every place I've worked RN can insert and X-ray done for placement. I don't see the difference between ngt and dobhoff. Ones smaller and both going to the same place

[applewhitern, BSN, RN]

A Dobhoff, or any type of weighted tube, placed by stylet, cannot be checked for placement via "air burp" method. It must be checked via Xray, then we would place the patient on their left side for a while to allow natural peristalsis to advance it further if needed. You never "re-insert" the stylet, as you could puncture something this way. At least this is how we nurses did them when I worked at hospitals that allowed us to. A Dobhoff or duotube or whatever type of weighted tube, does not have suction capability, and is not the same thing as a regular sump-type tube. Actually the goal is for it to float on past the stomach, into the duodenum.