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AUTHORIZATION IS GIVEN TO DISPENSE A GENERIC EQUIVALENT UNLESS THE PARTICULAR DRUG IS ENCIRCLED Diagnosis: _________________________________________________________________________________________ Allergies: __________________________________________________________________________________________ Weight: ___________________________________________________________________________________________ Physician’s Orders and Signature SMALL BOWELL FEEDING TUBE INSERTION (Dubhoff) Remove any existing Naso-gastric or Oro-gastric Tube. Pass Dobhoff tube transnasally to the first black mark. Administer Reglan 10 mg IV. Turn patient up on right side and advance tube to second black mark. Leave patient side for 2 hours, then turn supine and obtain KUB. If tube is reported by radiologist to be beyond pylorus, or in 2nd or 3d portion of duodenum, begin advancing tube by 3 cm every 30 minutes. After the tube has been advanced 3 times, turn patient on left side for 2 hours. When only 7 cm of the tube is still outside of the nose, advance tube to hub over stylet, and remove stylet. After the patient has been on the left side for 2 hours and Dobhoff tube is “hubbed,” return patient to supine position, place NGT to 2nd black mark from tip (in the opposite nostril) and obtain KUB. If KUB shows Dobhoff tube in jejunum, begin feedings as ordered. If Dobhoff tube is not in jejunum or if severe resistance is encountered at any point, CONTACT PHYSICIAN. Liquid medications only through the tube. Physician Signature _________________________ Date & Time _________________ DO NOT WRITE BELOW THIS LINE SOUTH CENTRAL REGIONAL MEDICAL CENTER PO BOX 607 - LAUREL, MISSISSIPPI 39441 SMALL BOWEL FEEDING TUBE FOR DOBHOF SBFTDBHOF July 2008 DO NOT WRITE BELOW THIS LINE