Nasogastric Tubes: Salem Sump vs. Dobhoff (Nursing)

00:00 So let's take a look at some common types of gastric tubes. So the first one you see here is commonly called a Salem sump tube. So when you see this device here, you see there's a blue vent port. Also, you see a suction or a bolus port. So in this suction port, this is typically where we can hook this to wall suction or we can administer feedings and medications through here. And next, you're going to also see a different type of tube called a Dobhoff tube. So you see our infusion port here? And also note on this which this is going to be important away the tip at the end of this tube. And we're going to get in to these tubes a little bit more thoroughly later. So now let's take a look at the Salem sump or NG tube.

00:50 This one is going to be one of the most common nasogastric tubes used. We really love this one in nursing because it's a little bit wider, you can put meds down this, you can use it for suctioning, you can use this for decompressing the stomach and administering dye like we had discussed earlier. So this one really has a lot of different uses for us. Now when we're talking about sizes, you're usually going to use about 14 to about 18 French and I'll show you a size comparison chart in a little bit. So if you take a close look at a Salem sump tube, you're going to notice this tube has centimeter markings for us. This is going to be really helpful in regards to placement and notice at the end there's a radiopaque marker at the tip to check for position when we place it on the x-ray. So looking at those ports we talked about earlier, if suction is needed, the larger bore is connected to suction tubing.

01:46 We also uses port for med delivery and also feeding if we need it. Now let's take a look at this blue air vent port. We typically in nursing forget what this is about. Now I want to tell you, on this port it is an air vent port, we do not put anything down this port and that is key. So again, nothing down the blue air vent port. So we're going to use this port, this is out open to air, this helps basically equalize the atmospheric pressure. It helps to equalize vacuum pressure in the stomach to prevent damage to the stomach lining. So why this is really important. And also the same blue port, it's going to help prevent reflex of the stomach contents by having that port maybe above the patient's waist, for example, and utilize the filter cap. So again, nothing goes in the blue air vent port and on that other large port. This is where we're going to use it for suction, feeding, or med delivery. So now we talked about these types of tubes. We just discussed how they can be used in different ways, but I want to pause for a minute and discuss the question with you. So you may see an OG or a nasogastric NG tube. So what's the difference? What's really just all about how it's placed. So you may see an order for a nasogastric tube like we've been talking about, or you may see an order for an orogastric tube. The only difference here is it's placed nasogastric meaning down the nose or orogastric meaning oral down the mouth. Now, you're really going to use the nasogastric most of the time. It's really pretty rare that we use orogastric tubes. Now if we do use an orogastric tube placement, that's typically placed for maybe short term in a surgery for example. Now let's take a closer look at that Dobhoff gastric tube we showed you earlier. Now this is a really special type of NG tube. Now this one is much smaller around in circumference and this is way more flexible than a Salem sump tube. Now when we talk about placement earlier, I will tell you as a nurse this one's way more difficult to place because it's very thin and is a lot more flexible. Now the nice thing about a Dobhoff tube, this is definitely more comfortable for your patient than the larger nasogastric or Salem sump tube that we talked about earlier. So the other thing to think about with the Dobhoff tube? These are really great for enteral feedings and medication delivery. One thing I want to talk to you about, and we'll revisit this later, is that we do not use Dobhoff tubes for suctioning. I'll repeat that again, we do not use a Dobhoff tube for suctioning. The other advantage of a Dobhoff tube is it's much smaller. So, if maybe a patient has facial trauma for example, they may have to use this route. Now, this Dobhoff tube is also inserted by a nurse. So when we insert this, we use this and there's a guide wire that runs down the whole length of this tube. Now, this is really important because once you insert a Dobhoff tube, the guide wire has to stay before you take an x-ray to make sure you have proper placement. So one thing to note, you never want to remove the guide wire before an x-ray to confirm placement. That guide wire is in there so we can catch that tube on an x-ray and make sure it's ready to use. Now let's take a look at this chart really quick. This shows a comparison of gastric tube sizes. You can see it ran from 6, which is much smaller, all the way to 24. Now, we talked about earlier that Salem sump or NG tube runs about 14 to 18 French where you can see this in the middle. That's a pretty good size.

05:46 Now, when we're talking about the Dobhoff tube, for example, it's going to be closer to maybe even a 6, maybe even smaller. So you can see a size comparison how much smaller that Dobhoff is in circumference. Let's take an anatomical look of when we insert a nasogastric tube where we started to the nostril and end up into our stomach or small intestine. So, see here we've got our nasogastric tube going through the nare. Now, you can see how it's being advanced from the back of the throat into the nasopharynx. Now notice here, we see a chin-to-chest how the patient has moved their chin down. This is really key on insertion because this is going to help facilitate the tube back into the esophagus and not into the trachea, and that's really important. Now, this gives you a great view of how long those nasogastric tubes can be in all the way it travels. So, remember, we went through the nose all the way down to the back of the throat, way down our esophagus and it's got to enter into the stomach at the very minimum. So, sometimes we can advance this if need be to reduce aspiration into the jejunum of the small intestine. So it will travel even further.

07:04 Now let's look at a quick summary of those tubes that we discussed earlier. We have that nasogastric NG tube or Salem sump and we have that small circumference Dobhoff tube.

07:15 So let's take a look at both. So when we're talking about insertion point, that nasogastric tube or Salem sump can go from mouth or oral and now that Dobhoff is only going to go down the nare when we insert it as a nurse or a student, obviously with supervision. Alright, so we're talking about the insertion point. These tubes can either end up pass into the stomach or into the jejunum. Now both of these are capable of tube feeding, which is great, but I want you to notice the key difference here. So notice when we're talking about decompression or suctioning, that the nasogastric and the Salem sump is the one that can be used for suctioning, not the Dobhoff. Key note, Dobhoffs we can't use for suction. And again, like we had just shown you earlier on that chart, notice the Salem sump is much bigger than the Dobhoff tube.