Dobhoff Tube Placement

[bobnurse]

I have a question for anyone who can help me.

At our facility we x-ray all feeding tubes for placement verification. We had a situation where a dubhoff did not show up anywhere on the x-ray. The wire was left in. It was a 12 french by the way. The nurse is sure of gastric placement. We told the nurse to check by air bolus while we await a second xray to be completed and read. The charge nurse said you can never hear air through a dubhoff and to pull it and reattempt insertion. So my questions are this:

1. Can u not check placement (initial verification) by air bolus. I am not

saying to use air bolus instead of cxr, but as a initial verification.

2. If CXR confirms placement, then how do you check placement every shift,

before meds and feedings? Do you do a CXR every 12 hours (Just kidding)

I've worked in facilities in the past where air bolus or ph testing was done as the only verification (dangerous, i now know). I believe there are facilities that probably do it. I could hear air easily through a 12 or 10 french, even 8's....smaller, sometime difficulty arose....

So is it just me, or do any of you hear air auscultation via dubhoffs?

Thanks,

Bobby

P.S. Just to make sure everyone is clear, im not saying to do air bolus over xray verification.

[kimtab]

After tube placement, the tube is not used until placement is confirmed via CXR. But after that I check by air bolus. On assessment, and every time you use the tube (flush, meds, whatever). I can hear an air bolus on auscultation.

[Toddeus5]

Okay, here's a question regarding Dobhoff tube placement:

After recently reading an update to our Policy and Procedure for gastric tube placement, I noticed a statement which instructed the RN to leave the guidewire in-place until after radiographical confirmation was obtained. This seems to be the opposite of what I was taught (and practice) for a variety of reasons.

1) The tube is radio-opaque (especially the weighted metal tip), which is easily identifiable via CXR.

2) Sure, CXR placement is the gold standard for confirmation of placement, but what can happen to small-bore feeding tubes when you try to withdraw the guide wire?......They can migrate up the GI tract and lead to larger problems when someone begins tube feeding after receiving a satisfactory XRAY.

3) The longer the tube stays in direct contact with the guide wire, the greater the chance of adherence secondary to gastric juices, body warmth, etc.

Thus far, I haven't really found any literature supporting or disputing this practice. Among my colleagues, they seem to agree with this rationale. Does anyone know of any resources which could help clarify this issue? I've checked most of the common sites.

Thanks,

Toddeus5

[MarkW56]

Sorry, I don't have the references handy, but CXR is the definitive test, but as you stated once the guide wire is removed it could then become displaced - I believe however the incidence is insignificant. All feeding tubes should be checked by at least two means - one of those is to check for pH levels, the real caution here is if the individual is on a PPI or some other acid reducing medication. Hope this helps - when I did research on this some time ago, it was very hard to find data - maybe a research study at your institution would be a great idea.

[trinityamo]

Just FYI, a dobhoff should be checked with a KUB not a CXR.