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Small-bore Nasoenteric (Dobhoff) Tube Placement (2.3.6)

Small-bore Nasoenteric (Dobhoff) Tube Placement (2.3.6) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Procedures

2.3.6


UW HEALTH CLINICAL POLICY 1
Policy Title: Small-bore Nasoenteric (Dobhoff) Tube Placement
Policy Number: 2.3.6
Category: UW Health
Type: Inpatient
Effective Date: June 21, 2016

I. PURPOSE

To establish a clear and consistent standard of care for the placement of small-bore feeding tubes in the
inpatient setting.

II. POLICY ELEMENTS

Small-bore nasoenteric placement in patients shall be consistent with this policy.

III. PROCEDURE

A. General considerations for all patients
i. Indication: Nasoenteric small-bore tube placement is indicated in patients with a functioning
gastrointestinal tract who cannot meet their nutritional requirements by oral intake.
ii. Enteral feeding tubes should be placed with the use of a tracking device (Cortrak) whenever
possible to promote optimum safety of insertion and to avoid airway misplacement. Please refer to
Nursing Patient Care departmental policy #2.25, Placement of Small Bowel Feeding Tube Using
Cortrak Enteral Access System (Adult and Pediatric).
iii. Appropriate Orders: To obtain a consult for the Feeding Tube Team to place a tube at bedside,
enter a new order for Feeding Tube Bedside Placement-Adult. This order panel initiates a consult
to the Feeding Tube Team.
iv. During off-hours when the Feeding Tube Team is unavailable, a naso-gastric tube can be
considered until an enteral feeding tube can be placed with use of Cortrak.
v. Reinsertion: A non-functioning or an inadvertently removed small-bore tube should not be replaced
until the ordering practitioner has been notified. If reinsertion of the tube is deemed appropriate, an
order for reinsertion must be obtained and documented in the medical chart.
vi. Complications: Insertion complications with small-bore placement are documented in the literature.
Serious complications include inadvertent lung placement often resulting in a pneumothorax or
perforation of the gastrointestinal tract. Complications caused from inappropriate positioning of the
small-bore feeding tube can also occur resulting in an increased risk of aspiration.
vii. Clogged tubes: In the event that a feeding tube becomes clogged, refer to Nursing Patient Care
departmental policy #2.22, Unclogging Enteral Feeding Tubes (Adult and Pediatric).
viii. Placement Verification: Naso or oral enteric tubes require verification with an abdominal radiograph
to ensure appropriate tube placement. Once appropriate tube location is confirmed, an order is
obtained to begin using tube.
ix. Feeding tubes will be appropriately secured with the use of a securement device. Bridle
securement can only be done by the trained Feeding Tube Team member. Any readjustment of the
bridle securement is to be done by the Feeding tube team.
B. Feeding Tube Placement Team Information
i. For Clinical Science Center: Pager 7777. Hours of service: 0700-1800. Available 7 days/week.
ii. For the American Center: Contact the Care Team Leader on the Overnight Care Unit.
iii. Referral for alternative placements by Feeding Tube Team:
a. The team will suspend attempts to insert a feeding tube after 2 attempts when the tube is
tracking to the lung of the patient.
b. If the tube is unable to pass to the desired location the provider is notified with the
recommendation for tube placement in GI radiology or alternative therapy.

IV. COORDINATION

Author: Director, Nursing Operations Support
Senior Management Sponsor: SVP, Patient Care Services and CNO
Approval committees: Joint Practice Committee; UW Health Clinical Policy Committee; Medical Board
UW Health Clinical Policy Committee Approval: May 16, 2016




UW HEALTH CLINICAL POLICY 2
Policy Title: Small-bore Nasoenteric (Dobhoff) Tube Placement
Policy Number: 2.3.6

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

V. APPROVAL

Peter Newcomer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VI. REFERENCES

Taylor B, Mazuski J. Enteral feeding access in the critically ill. In: Cresci, G. Nutrition Support for the
Critically Ill Patient: A Guide to Practice. Boca Raton, FL: CRC Press; 2005:235-252.
Welch SK. Certification of staff nurses to insert enteral feeding tubes using a research-based procedure.
Nutr Clin Pract. 1996;11:21-27.
Cresci G, Martindale R. Bedside placement of small bowel feeding tubes in hospitalized patients: a new role
for the dietitian. Nutrition. 2003;19:843-846.
Marderstein EL, Simmons RL, Ochoa JB. Patient safety: effect of institutional protocols on adverse events
related to feeding tube placement in the critically ill. J Am Coll Surg. 2004;199:39-47; discussion 47-50.
Taylor B, Schallom L. Bedside small bowel feeding tube placement in critically ill patients utilizing a
dietitian/nurse team approach. Nutr Clin Pract. 2001;16:258.
de Aguilar-Nascimento J, Kudsk, K. Hidden costs in feeding tube placements. JPEN J Parenter Enteral Nutr.
In press.
Zaloga GP. Bedside method for placing small bowel feeding tubes in critically ill patients. A prospective
study. Chest. 1991;100:1643-1646.
MedSystems (2008) Cortrak enteral access system: Operators guide. Wheeling Ill: MEDSYSTEMS
Rivera, R.J. Campana, J.Seidner, D.& Hamilton,C. (2009). TN T26-1 Small bowel feeding tube placement
using an electromagnetic tube placement device: Accuracy of tip placement. Journal of Parental and Enteral
Nutrition, 33(2).

Nursing Patient Care departmental policy #2.22, Unclogging Enteral Feeding Tubes (Adult & Pediatric)
Nursing Patient Care departmental policy #2.25, Placement of Small Bowel Feeding Tube Using Cortrak
Enteral Access System (Adult and Pediatric)

VII. REVIEW DETAILS
Version: Revision
Next Revision Due: June 2019
Formerly Known as: Hospital Administrative policy #7.62