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Discussion

tubes--please help!

I know you can assess placement of an NG tube by testing the pH of gastric residuals and by injecting 30cc of air into tube and aucultating over abdomen. However, I am a little confused about small bore feeding tubes (like Dobhoffs) and gastrostomy tubes (PEG tubes). I am pretty sure you aspirate and check pH to check placement BUT can you inject 30cc of air and auculate over abdomen such as with an NG? I can't find a clear answer anywhere suprisingly!

Thanks so much:)

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Dobhoffs are placed in the duodenum and placement is verified through abdominal x-ray. According to the dietician on our ICU floor, residual is not to be checked on a dobhoff d/t the thin and flexible nature of the tubing, the force of checking residual can cause the tube to coil back on itself and come out of the duodenum.

The reason for checking residual is to verify that the feeding formula is being digested. If the residual is too large (>100 cc) then the formula is not being digested (exiting the stomach properly). Because the Dobhoff is placed beyond the stomach (into the duodenum) there is no need to check residual because the formula is being deposited into the intestinal system (and bypassing the stomach). There is also no need to check placement with air bolus because placement has been verified via x-ray.

The protocol on our floor for a patient with a Dobhoff is to check bowel sounds and palpate the abdomen q 4 hrs to verify good tolerance of tube feeds (bowel sounds present in all four quadrants and abdomen soft and non-tender).

PEG's are placed via endoscopy and therefore do not need to be checked for placement with an air bolus. However, residual is to be checked because the PEG is placed in the patient's stomach.

Excellent answer, complete with accurate rationale. (Show-off):wink2:

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