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Dobhoff Tube


  • 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

Relative Contraindications

  • 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)

Absolute Contraindications for blind approach

  • Facial trauma, basilar skull fracture, pharyngeal or esophageal trauma
  • 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

Pre-procedural considerations

  • 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

Procedural Considerations

  • 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

Post-procedural Considerations

  • 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