Dubhoff insertion???

Please any ideas would be appreciated:):)

Is that a nursing function now? It was always the doc's job when I was an ICU nurse. We put in Salem-sumps but that was it.

WE INSERTED DOBHOFF'S ON TELE. ONCE U GET THE TUBE DOWN, TRY INSERTING AIR W/A 60 CC SYRINGE TO HELP INFLATE THE STOMACH AND THEN ADVANCE THE TUBE

We put them in all the time on neuro. It's just like putting down a Salem only really it's easier because it's weighted and smaller diameter. Sit the patient up as much as possible, then do your measurements. When you measure for the Salem, you measure nose to earlobe, then to just below the sternum. When you measure for the DobHoff you measure to the umbilicus. If the person is cooperative (yeah right) have the person lean the head back a little to open up that angle from the nose. I lubricated the tip usually by dipping it in the glass of water I had. Then as you advance the tube, have the person swallow if they can (which isn't likely, is it), tuck the chin down, and continue to advance to where you have marked on the tube it should go. Putting the person on the right side afterwards, helps it move on down, and also reglan helps. But in my experience, they tend to go correctly. I always confirmed placement as with any other G tube (introduce air whilst listening, trying to withdraw stomach contents, and putting the end of the tube into a glass of water and looking for air bubbles) even though they were always x-rayed for confirmation.

You can remove the guidewire as soon as you are comfortable that it's in the right place, because the tip is radiopaque.

Also, the guidewire tip isn't occlusive, so if you're going to check placement by blowing air in, then you have to occlude that tip with your gloved finger so the air doesn't just blow right back out again. Where I was, for some reason, when we withdrew the guidewire, we looped it up and taped it to the closet wall. I don't know why we did that, as I can't imagine trying to re-introduce the guideware if more manipulation was needed later!

The icky thing about DobHoffs is their nasty tendency to curl up in the back of the patient's throat/mouth!!!

Ewwww - did you ever see a sling built to keep a DobHoff or NG tube? "I'm going to build this construct in your nose to remind you not to pull your tube out."

Love

Dennie

If the patient can swallow, fill a 60 cc syringe with ice water and have them suck on it while you advance the tube. The suction helps to pull the tube into the esophagus. Watch their throat and advance a little bit each time they swallow.

Speak to them in a calm gentle affirming voice while doing the procedure. It seems the more anxious a patient is the harder it is to insert the tube.

We're always required to confirm placement by x-ray.

Linda

Thank you for your suggestions!!! I expect to have better success next time I insert one (thanx to y'all) :):):)

just becareful not to puncture a lung. i have seen 3 doctors do this (not a nursing function at my hospital), and cause lots and lots of problems. not good. i don't like dobhoffs...

Thanks for the warning... I can see how easy this can happen if the dubhoff just happens to slide down the wrong "hole" (trachea vs esophagus). Any ideas on preventing this from happening???

It has probably been a decade since I put in a Dobhoff. I think I wouldn't mind having one as a patient (more comfortable than your standard n-g tube) but inserting them was a fully underappreciated procedure when I was doing them/when they first came out.

My biggest word of caution is they can be amazingly well-tolerated in the trachea SO xray confirmation of placement is mandatory.

when I was doing it, getting it to the duodenum was understood to probably take some time (hence, the weight, to let mother nature do the work) so getting it to the stomach without curling it was the goal. Has that changed?

Where I work....the doctor or resident inserts them under fluoroscopy. We use to insert them into the stomach and then send the patient to fluor but...unfortunatly we placed a few in the lung(we never started feedings thank God!)

So now we have the doctors do it all...which is fine with me!

At the first hospital I worked at, the RN's placed Dobhoff's. We used a two step procedure. First inserting the tube to the first black mark(I thinK) on the tube, then obtaining a CXR. If the tube was where is was supposed to be, then we advanced the tube the rest of the way down--to where we had marked the tube ourselves. Then we got a second CXR. If, after the first step, the tube was in the main stem Bronchus the doc had to come and remove the tube. Once, while placing a dobhoff for a colleague as she had never done it, I put the tube in the pt's lung! The resident had to come and remove the tube, they got a CXR, pt had a pneumo and was transferred to ICU. I felt horrible but know that that is one of the risks of placing Dobhoffs.

I disagree with NurseDennie, I think that they are harder to place than regular NG's because you run a higher risk of placing the tube in the lung with the smaller bore tubes. The hospital I work at now, the Radiology doc places the dobhoff under fluoroscopy. Thank god for that!