Dobhoff Tube¶

Indications¶

Enteral feeding and medication administration if unable to swallow
DHT v NGT: DHT deliver meds and fluids, NGT provide suction to decompress (can also deliver meds/fluids); nurses place NGT, residents (and ICU nurses) place DHT qUh5AJ5uIZo

Esophageal varices or strictures (most hepatologists say this is not a contra-indication, but discuss if recent bleed or recent banding)
Other altered gastric anatomy that may prevent passage. (i.e. gastric bypass, esophageal hernias, tumors or other possible obstructions)
SBO or ileus (use NGT instead for suction)

Common risks: malposition (lung -> pneumothorax or pneumonia; pyriform sinus; coiling anywhere along tract); perforation anywhere along the tract; aspiration, nasal ulceration, esophagitis, gastritis, bleeding, vagal response, discomfort

Bleeding risk guidelines: Plts > 10k, no specific INR guidelines
Make sure DHT and bridle sizes correlate
Measure expected advancement depth by measuring distance from tip of nose, around ear, and to xiphoid process
Prior to placement, fasten the stylet in the fully-hubbed position to reduce bending and folding over of the weighted tip while advancing
Apply anesthetic with lidocaine gel (order Lidocaine uro-jet) and nasal swab to reduce pt discomfort, reduce gag reflex, and assist with clearance of the nasal passages
Consider fluoro-guided placement after 3 failed bedside attempts
Post-pyloric placement
- Consider in patients with high pulmonary aspiration risk, severe esophageal reflux/esophagitis, recurrent emesis, impaired gastric mobility, and pancreatitis
- Refer for fluoro-guided post-pyloric advancement after 1 failed bedside attempt

Have the patient sit upright with their head tilted toward the chest to encourage posterior oropharyngeal positioning of the DHT while advancing
Tip: advance horizontally (nose tip to ear lobe), not angled up
If pt can participate safely, have the patient swallow in conjunction with advancement; pt can suck on straw (with small sips of water if low aspiration risk) to utilize pharyngeal muscles to position DHT into esophagus
Place bridle and dog-bone tape while at the bedside to reduce dislodgement
Excessive coughing, difficulty phonating, or resistance may indicate tracheal placement; withdraw tube and re-attempt. Consider Duonebs to reduce bronchospasms
Post-pyloric placement has been shown to be up to 90% successful with intermittent insufflation of 10-20cc of air ~every 10cm of advancement after 55cm to promote pylorus opening. IV Reglan or erythromycin may also help
When placing bridle (recommend AFTER xray confirmation), keep alignment markers (marked on both probes) together so magnetic tips will align once past the nasal septum
When placing the bridle, remove the green stylet housed within the white probe before retracting back and removing the white probe

ALWAYS confirm position radiographically via KUB before medications are given!
Insufflation of air and auscultation of bowel sounds over the gastric area can be reassuring of correct placement of DHT prior to taping/bridling and leaving the bedside
Most mispositioned/coiled tubes have to be removed and re-attempted, but it is ok to advance or withdraw if Stylet is still in place. However, once removed, a stylet should not be re-introduced to a mispositioned/coiled tube due to risk of GI perforation
In case of cranial placement, don’t remove, consult NSGY
De-clogging: Clog Zapper Kit (can type this into Epic directly); coca cola