Indications for use

• A small-bore, flexible silicone tube usually inserted into the nose with a weighted tip that should preferentially be past the pylorus
• Used for nutrition in patients who
  • Require mechanical ventilation
• Have an altered mental status
• Have swallowing disorders
• It is a narrow-bore (3mm-8 French) which can be left in place for 6 weeks or more
• Causes less local irritation than nasogastric tubes
• Unlike a large-bore nasogastric tube, it is not attached to suction 

Placement

• The feeding tube has a weighted metal tip and a guide wire for insertion
  • The side hole is usually located just proximal to the tip
• Tip of feeding tube should be in 2^nd or 3^rd portion of duodenum
• Most, however, are placed in the stomach
• Placement of the tube is checked by a post-insertion radiograph centered on the region of the lower chest and upper abdomen
• Once the guide wire is removed, it is not re-inserted 

Complications

• About 2% tracheopulmonary complications
• Positioning in the stomach
  • If the tube is placed too proximally, there is a risk of aspiration
• Inadvertent insertion into the tracheobronchial tree
  • The tube is more likely to enter to the right main bronchus and lower lobe bronchus because of the wider diameter and straighter course than the left main bronchus
• Perforation of pleura by guide wire or tube
  • Pneumothorax
• Intracranial placement
  • Very rare

* There does not seem to be general agreement as to whether the correct spelling is Dobhoff or Dobbhoff, even among medical dictionaries, although “Dobbhoff” is the registered trademark of Sherwood Services AG. The tube was actually named after two physicians, Drs. Dobbie and Hoffmeister.

Four Different Patients with Dobbhoff (feeding) Tubes. (A) The tip of the feeding tube (white arrow) is in the right lower lobe bronchus, having descended in the trachea instead of the esophagus. (B) The tip of the Dobbhoff tube is in the descending limb of the duodenum (yellow arrow), considered the best position. (C) The tip is in the cervical esophagus (dotted white arrow). (D) The tip is in the distal esophagus (black arrow).
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