Did I overreact?

**canoehead, BSN, RN** · Jun 3, 2007

My vote would have been to push it pack in place and auscultate air in the stomach- then you are good to go. It should have more than just an inch tip in the stomach to begin with anyway.

jellybean_1 · Jun 3, 2007

I would have done as canoehead said, personally being a new grad I would have asked another nurse for her input , before calling the physician.

all4schwa · Jun 3, 2007

If the tape or marker were on the tube and it really was just about an inch, I would push it back in and secure it better. If there were any doubt, I would get a KUB.

reesern63, RN · Jun 3, 2007

I would have done as canoehead said, personally being a new grad I would have asked another nurse for her input , before calling the physician.

Agree with above. You would have solved your problem in under 5 min.

Daytonite, BSN, RN · Jun 3, 2007

Aren't Dobhoff's still inserted with a guidewire stylet? If the tube comes out, even an inch, it's out for that inch. My understanding is that the only way it will reinsert is to allow peristalsis to carry it down into the duodenum. It can't be pushed in.

luvkitties. . .(I love kitties, too. I've got 3 of them.) I wouldn't have called the doctor for one inch of tubing coming out. It is important to know where the distal tip is located in the person's anatomy. I would always start out my shift by getting a baseline measurement on the length of tubing that is "outside" the patient (from the tip of the nose to the outer port). If a question of tube displacement arises, I can merely measure the amount of tubing from the nose to the outer port. If it has increased in length by several inches, I would try to assess for placement of the distal tip. These tubes, however, are often in the first part of the duodenum. Then I would call the doctor.

trudlebug · Jun 3, 2007

Dobhoff tubes usually are inserted into upper part of the small intestine. If you heard gastric auscultation then it is out too far. Also, they are inserted with a guide wire, so pushing it back is probably not going to work.

Plain NG tube, yes, push back and auscultate, but not dobhoff - you need a KUB to verify placement

mom4josh · Jun 3, 2007

I agree with the other responders. Probably would have asked my charge nurse or another experienced person first for their input... that is what they are there for.

BULLYDAWGRN, RN · Jun 3, 2007

I see no big deal,I think you did fine, you assessed the situation on your own and using your nursing judgement. You went through the basic steps to try to identify if the tube was in place or not, apparently your little voice inside you told you to get an order for kub to be sure of visualized correct placement, good, pay heed to that little voice more often. Maybe later own after more hands on with dobhoff tubes you'll be comfortable enough to satisfy yourself with placement by other means but if it makes you feel more comfortable to get the kub, by gosh call xray up to get a picture.

Karen_tn_37211 · Jun 3, 2007

As a new nurse you did just fine....whenever in doubt call the doctor or seek help from somebody. Too many new grads think they know everything. Where I work the policy is to always verify placement of a Dobbhoff by KUB...one inch, two inches, it does not matter.

luvkitties · Jun 3, 2007

Oops...forgot to mention that I did ask another (experienced) nurse first, and we tried to find documentation of the tube measurement, but couldn't find it...she also thought it would be a good idea to call the physician just to be safe.