The insertion of a Dobhoff (small bowel) feeding tube is a common procedure in healthcare settings. A crucial step after placement is confirming correct positioning via X-ray and then safely removing the guide wire. This guide provides a detailed explanation of the process, emphasizing safety and best practices.
Understanding Dobhoff Tube Placement and the Guide Wire
Dobhoff tubes are typically placed to provide nutrition to patients who cannot eat orally. The guide wire, also known as a stylet, is a flexible wire inserted into the tube to provide rigidity and facilitate insertion. Once the tube is in the desired location (typically the duodenum or jejunum), the guide wire needs to be removed carefully.
Step-by-Step Guide to Removing the Guide Wire
1. Confirm Correct Placement with X-Ray:
Before removing the guide wire, always confirm the correct placement of the Dobhoff tube via abdominal X-ray. This is a critical step to prevent complications like misplacement into the lungs or esophagus. As demonstrated in Image 9 below, tubes can coil and loop back on themselves, potentially ending up in the esophagus.
2. Prepare the Patient and Equipment:
- Explain the procedure to the patient to alleviate anxiety and ensure cooperation.
- Gather necessary supplies:
- Clean gloves
- Gauze pads or tissues
- Water-soluble lubricant (if needed)
- Appropriate disposal container for the guide wire
3. Gentle Removal Technique:
- Stabilize the Tube: Hold the Dobhoff tube securely at the insertion site (nare or mouth) to prevent dislodgement during guide wire removal.
- Slow and Steady: Gently and slowly pull the guide wire out of the Dobhoff tube. Avoid forceful pulling, as this can damage the tube or cause discomfort to the patient.
- Observe for Resistance: If you encounter resistance while removing the guide wire, do not force it. This could indicate kinking or obstruction within the tube.
- Troubleshooting Resistance:
- Slight Rotation: Try gently rotating the guide wire back and forth while applying gentle traction. This might help dislodge any minor obstructions.
- Lubrication: If rotation doesn’t work, a small amount of water-soluble lubricant can be instilled into the tube (if not contraindicated) to facilitate removal.
- Withdrawal: If resistance persists, gently withdraw the guide wire and the Dobhoff tube together a few centimeters. Then, attempt to remove the guide wire again. If still unsuccessful, consult with a physician or experienced nurse.
- Maintain Sterility: Be careful not to contaminate the portion of the guidewire that will be re-inserted into the tube should repositioning be necessary.
4. Post-Removal Check:
- Inspect the Guide Wire: After removal, inspect the guide wire for any damage, such as kinks or breaks. Discard the guide wire properly in a designated sharps container.
- Verify Tube Patency: Flush the Dobhoff tube with a small amount of water to ensure patency.
5. Secure the Tube:
- Secure the Dobhoff tube appropriately to prevent accidental dislodgement.
Important Considerations & Troubleshooting
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Coiling in the Stomach: If the initial X-ray reveals the feeding tube is coiled in the stomach (as seen in image 10) at the 80-90 cm mark during Step Two of placement, do not advance the tube further. Instead, remove the wire and attempt gastric feeding. Advancing more tube will only result in large loops of coiled feeding tube which can lead to knotting if the wire is removed.
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Kinking at the Duodenum: A kinked feeding tube (Image 7) may indicate improper placement, preventing advancement of the tube. Do not force the guidewire in these situations.
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Patient Comfort: Throughout the procedure, monitor the patient for any signs of discomfort or distress.
When to Seek Assistance
- Significant resistance during guide wire removal.
- Suspected tube damage.
- Any concerns about tube placement or patient well-being.
Conclusion
Safe removal of the guide wire from a Dobhoff tube is paramount to prevent complications and ensure effective nutritional support. By following these steps and paying close attention to potential issues, healthcare professionals can perform this procedure with confidence and competence. Always prioritize patient safety and seek assistance when needed.
