Dobhoff Feeding Tube Removal
A Dobhoff is a feeding tube that is inserted in the nose, goes through the oesophagus and into the stomach. It is commonly utilised in critical care units because intubated patients cannot eat--they require a machine to help them breathe and are sedated.
Food in the form of liquid supplements, like Boost, Ensure or Carnation, is delivered through the tube to provide nutrition and calories. Dobhoff tubes are only utilised for several weeks, after which a more permanent solution must be sought.
Taking Out the Dobhoff
Wash your hands and don gloves. Instruct the patient to sit up in bed with his head at a 30-degree angle with his feet. Wrap a towel around his shoulders to prevent fluids from splashing onto his clothes. If he is receiving continuous feedings through the Dobhoff, turn off the pump and flush the tube with 30cc water. Otherwise, flush with 10cc saline or 30cc air to clear any fluids--water or nutritional supplements--that may be at the distal end of the tube.
The Dobhoff is secured to the patient's nose with several pieces of tape. Gently lift the tape--use adhesive remover, if necessary, to prevent irritating the skin. Clamp the Dobhoff with your finger and thumb. Ask the patient to take a deep breath and hold it--this will decrease the possibility of aspiration when the tube is being withdrawn--and let him know that he may feel like vomiting. Immediately pull out the Dobhoff and discard it in a trash bag along with your gloves. Hand the patient some tissues to wipe his nose and ask if he would like to brush his teeth or rinse his mouth. Observe him for the next two to four hours, as he may feel bloated. Nausea and vomiting are also possible.
The Next Step
Dobhoff tubes are usually pulled after several weeks. Long-term use can irritate the nasal passage or increase the risk of aspiration from feedings. If the patient is unable to eat without the tube, if she is unable to consume enough calories, or if she is at risk for aspirating oral fluids, one long-term solution is a gastric tube. A gastric tube is surgically inserted through the abdomen and can be left in place for extended periods of time. However, it must be changed every few months, which can easily be done in the clinic. People with gastric tubes include those with stroke, oral cancer, and Tay-Sachs disease.