#Dobhoff

[doctoraxiom]

It's only been an hour with this pH probe down my throat and I already have a new appreciation for everyone who I've taken care of who had a dobhoff tube in and I was like "If you can just eat enough, we can take out the feeding tube!"

Eating and swallowing with this thing is really uncomfortable.

[meghanester]

Nasogastric Tube Market Growth with a CAGR of Approximately 6% During 2023-2035 and Attain Around USD 1000 Million by 2035

Research Nester’s recent market research analysis on “Nasogastric Tube Market: Global Demand Analysis & Opportunity Outlook 2035” delivers a detailed competitors analysis and a detailed overview of the global nasogastric tube market in terms of market segmentation by tube, patient group, indication, end user, and by region.

Growing Admission of Patients in ICU to Promote Global Market Share of Nasogastric Tube

The global nasogastric tube market is slated to grow majorly on account of the rising demand for ICUs from critical patients and higher cases of chronic diseases. People hospitalized in the ICU are in critical condition and have difficulty swallowing medications. These medications are administered via a nasogastric tube. Some patients acquire pneumonia during the course of COVID-19, with typical abnormalities on chest CT. This resulted in significant breathing issues, food swallowing, and other issues. Patients with severe symptoms are transferred to the intensive care unit (ICU), where mechanical ventilation is frequently required. The covid patients' preexisting chronic conditions exacerbated their situation. Moreover, nasogastric tubes can be used to drain excess fluid or prevent aspiration in some chronic diseases, such as pancreatic disorders or ailments with significant fluid accumulation in the belly. According to the World Health Organization, noncommunicable illnesses kill over 41 million people each year. 17 million of whom die before the age of 70. Get a Sample PDF Brochure: https://www.researchnester.com/sample-request-5016

Besides this, the market growth is also attributed to growing cases of surgical procedures followed by increasing demand for enteral feeding. A nasogastric tube is introduced during surgery to remove accumulated air, fluid, or gastrointestinal contents from the stomach. Furthermore, the body is too weak to absorb and swallow solid foods when recovering after surgery. Enteral feeding is thus employed to give appropriate therapeutic nutrition. Moreover, nasogastric tubes are a reasonably easy and non-invasive technique of enteral feeding in the intensive care unit. They are a temporary solution that is easy to implement.

Some of the major growth factors and challenges that are associated with the growth of the global nasogastric tube market are:

Request for customization @ https://www.researchnester.com/customized-reports-5016

Growth Drivers:

• Surging Demand for Enteral Feeding

• Rising Cases of ICU Admissions and Surgery

Challenges: There are various different methods that can be used for enteral feeding and there are no proper reimbursement policies for the manufacturers of nasogastric tubes are some of the major factors anticipated to hamper the global market size of nasogastric tube. There are alternative methods for enteral feedings, such as gastronomy tubes, or jejunostomy tubes, which may be preferred over nasogastric tubes in certain patient populations. On the other hand, the infection caused by these tubes is also expected to stifle market expansion. Infections such as bloodstream infections and pneumonia might be increased by improper insertion, inadequate care, or prolonged use of the tube. These all problem cause discomfort and irritation for patients.

On the basis of tubes, the global nasogastric tube market is segmented into levin catheter, dobhoff tube, sengstaken-blakemore tube. The Levin catheter segment is to accumulate the maximum revenue through 2035, by growing at a significant CAGR in the upcoming years. The Levin catheter is becoming highly popular, owing to better health services provided at hospitals, which aids the treatment of the situation that increases the need for nasogastric tubes. Moreover, by patient group, the market is fragmented into geriatric and adults, the geriatric segment will grow significantly owing growing population of old adults. Older people have difficulty ingesting appropriate nutrients orally for a variety of reasons, including weak appetites and medical issues. Nasogastric tubes aid in their hydration and nutritional maintenance.

Obtain this Report @ https://www.researchnester.com/reports/nasogastric-tube-market/5016

By region, the North American nasogastric tube market is to generate the highest revenue between 2023 and 2035. Market expansion is anticipated to be fueled by rising admission to ICU and the establishment of various regulatory rules. More than 6 million people are admitted to an intensive care unit (ICU) in the United States each year. Moreover, by late June/early July 2020, overall non-COVID-19 admissions in the United States had grown to 16 percent of pre-pandemic baseline volume. Furthermore, the regulatory guidelines will promote the manufacturing of better and high-quality products, which will aid in market growth.

This report also provides the existing competitive scenario of some of the key players of the global nasogastric tube market which includes company profiling of QMD, Angiplast Pvt. Ltd., Securmed, Vygon SAS, Medtronic, Andersen Products Ltd., Cardinal Health, Baihe Medical, and Poly Medicure Limited.

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[mcatmemoranda]

I thought a Dobhoff was the same as a NG tube, but Dr. Barclay explained it to me. A Dobhoff is the tube that only lets you put nutrition into the stomach. A NG tube lets you put stuff into the tube and suck stuff out through it; it has a channel that goes in and one that goes out.

[annastudyskills]

a little update on how my med-surg clinicals are going! yesterday i was able to:

- set up my first IV drip 

- assist with a straight catheter 

- do a head-to-toe assessment

- an assessment of the cranial nerves 

- assess using the NIH stroke scale

- learn how to give medications via a dobhoff tube 

- collect a urinalysis 

although this may be simple tasks to some, i was very excited to do all these tasks! (i’m the biggest nerd for nursing) 

hope everyone is having a great day! 

♡ quick links

- these color swatch sticky notes

- etsy shop

- free printables, wallpapers, digital stickers!

♡ tag me! @annastudyskills​ | #annastudyskills

[houlihans-roots]

im in a hospital for the next 6 weeks on rotation and im always like wow just like on mash except not at all. but Hawkeye would somehow help invent Dobhoffs in the 70s according to mash .

i rounded w a cardiovascular OR doctor today in the ICU that was so obsessed w teaching that he made the young, confident, fresh-out-of-residency doctors to two nervous messes . and for why

[baggettsathome]

At long last: Some really good news!

Nate has managed to avoid too much more excitement since our last post and, in fact, we have some great news to share! The current plan is for Nate to be home for Thanksgiving! Just a week ago, discharge seemed to be a distant dream, so we were pretty surprised when things came together to hopefully get Nate home soon. He’ll be readmitted the week after (we’ll get to that later), but the hope is for him to get 5-6 days at home, including time for a holiday meal with loved ones.

Talking with a few members of the liver transplant team about the plan for the next few days which, for the first time in a long time, includes time at home!

There’ve been several trips back and forth from Interventional Radiology over the last week. Nate’s managed to lose a couple of drains and gain a couple of more. At this point, he’s up to five drains + his bile drain. One of those, right below his sternum in his xiphoid process, has been particularly painful. On Monday, he’s headed back to IR again to see if it might be able to come out, plus or minus a couple of other drains. It’d be great to go home with a few less “accessories,” but we’ll also be ready to take care of however many we have to.

Enjoying dessert with our friend Meaghan visiting from Boise!

At this point, controlling the infections in Nate’s abdomen is one of the team’s primary concerns. The drains are a part of that, helping to remove any infected fluid from his body. The antibiotics are another part. We know that the bugs in Nate’s belly are already resistant to several antibiotics and seem to be developing more of that resistance. So Friday he started a drug, eravacycline, that was just approved earlier this year to treat abdominal infections.  But thankfully, Nate’s overall antibiotic regimen has started to become simpler as he’s finished his courses of some of the other medications (meropenem and linezolid). When we get home next week, we should just have to give the eravacycline twice a day.

Thank you to the Kreckos for the lights to make our hospital room a little cozier as the holiday season approaches!

The plan for the next week is for a scan on Sunday evening to check on the fluid collections in his belly and see if any of the drains can be removed or need to be repositioned. After any drain follow ups, we’ll head home on Tuesday! We’re hoping Nate continues feeling well enough to stay home through the post-holiday weekend. Then, early during the week after Thanksgiving, we’ll come back to the hospital for a planned readmission.

During that readmission, they’ll do another capping trial. That’s when they close off the tube for the bile drain so that the bile drains into his small intestine again instead of out of his body. The capping trial a couple of weeks ago was when Nate spiked a fever, his blood pressur dropped, and he had to go down to the ICU for a little while. So it definitely isn’t something we want to try out at home without his nurses and doctors around to help, if needed. If he goes a couple of days after capping without getting a fever, we’ll get to go home again and that time, without a planned readmission! If he gets a fever again, we’ll be where we need to be to treat the new infection.

Since he’s been able to eat again, Nate has been craving tacos, but hospital and take-out ones just weren’t cutting it. But these homemade ones from a very generous friend were JUST what he’s been dreaming of!

Bile in your intestines helps your body digest food, so a big advantage of closing off the bile drain is that it should make it easier for Nate to gain weight and strength. Eating real food without the dobhoff feeding tube or any IV nutrition has been going really well, but Nate still needs to gain a lot of weight to get back where he should be. And he also needs the calories to keep up with all the exercising he’s been doing. For the last couple of days, Nate has been able to walk a mile at a time around the hospital!

Working hard with OT on balance and strength exercises.

We know that a lot can happen in four days, but we’re so hopeful that it’ll work out to be home for Thanksgiving. It’ll be Nate’s first time home in 82 days! When this admission started in August, Nate arrived in shorts and a t-shirt and we had the air conditioning running at home. Today, there’s a dusting of snow on the ground and heavy quilts on all the beds. We also know how nerve-wracking it can be to be home and in charge of everything ourselves. Nate’s drains will all need to be taken care of and he’ll need twice-daily IV infusions. Thankfully, we have some practice from last year. Still, we know we’ll miss having all our favorite B4/6 nurses around to take care of us.

Hopefully our next update will be written from the comfort of home!

[latestanalysis]

Global Medical Nasogastric Tubes Market Top Manufactures Swot Analysis, Size, Share, Relevant Growth Report Analysis 2020-2027

Qualiket Research delivers a latest published report on Global Medical Nasogastric Tubes Market industry analysis and forecast 2020 – 2027 providing a key insights and competitive advantage to clients through a detailed report. The global Medical Nasogastric Tubes Market exhibit steady growth throughout the forecast period. Several market drivers and restraints are analysed in the report, which delivers readers with a clear image of what’s driving and what’s holding back the Medical Nasogastric Tubes Market. The historical trajectory of the market is examined in the report in the report in order to provide a basis for predictions regarding the market’s growth rate during the forecast period.

Impact of COVID-19 on Market

Growing number of COVId-19 patients with respiratory failure is expected to accelerate the demand for medical nasogastric tubes market growth during this forecast period. The outbreak of COVID-19 has been increasing at an exponential rate. This has led to the need to improve patient care & offer added nutritional support to patients affected by the virus.

Request Sample of This report @ https://qualiketresearch.com/request-sample/Medical-Nasogastric-Tubes-Market/request-sample

Key Players

Some of the key players are listed in the report such as Guangdong Baihe Medical Technology, Bicakcilar, Bard Medical, Pacific Hospital Supply Co. Ltd, Andersen Products, Degania Medical, Cardinal Health, Cook Medical, Rontis Medical,Poly Medicure Limited, etc.

Market Taxonomy

By Type

· Levin Catheter

· Dobhoff Tube

· Sengstaken- Blakemore Tube

· Others

By Patient

· Pediatric

· Adult

By End user

· Hospitals

· Clinics

· Others

By Region

· North America

· Latin America

· Europe

· Asia Pacific

· Middle East & Africa

Browse Full This Report @ https://qualiketresearch.com/reports-details/Medical-Nasogastric-Tubes-Market

About Us

QualiKet Research is a leading Market Research and Competitive Intelligence partner helping leaders across the world to develop robust strategy and stay ahead for evolution by providing actionable insights about ever changing market scenario, competition and customers. QualiKet Research is dedicated to enhancing the ability of faster decision making by providing timely and scalable intelligence. We use different intelligence tools to come up with evidence that showcases the threats and opportunities which helps our clients outperform their competition.

[jadhavsweety]

Global Medical Nasogastric Tubes Market Technology, Application,Manufacturers, Trends and Development, Upcoming Projections 2027.

The Global Medical Nasogastric Tubes Market is studied in detail in the new report on Qualiket Research Website. The new research report studies the Global Medical Nasogastric Tubes Market by profiling its major driving and restraining factors, compiling a comprehensive database on the market’s historical growth trajectory and present conditions, & allowing easy formulation of calculations as well as estimations by the use of industry-leading analytical tools & methods. The key economic aspects affecting the Medical Nasogastric Tubes Market growth are studied in detail in this report, including a detailed assessment of the microeconomic & macroeconomic environment of the market.

Nasogastric tube is passed by means of the nose and down through the nasopharynx and throat into the stomach. It is an adaptable tube made of plastic and elastic and it has bidirectional potential. Insertion of an organic tube, helps gaining access to stomach and its contents. These tubes are used for are suitable for enteral feeding up to six weeks.

Get Sample Copy of this Report @ https://qualiketresearch.com/request-sample/Medical-Nasogastric-Tubes-Market/request-sample

The report contains a thorough study of the global Medical Nasogastric Tubes Market. It has successfully pointed out the key factors that have substantial impact on the Medical Nasogastric Tubes Market. This report is based on result of a well-planned research methodology. The methodology employed both primary and secondary research tools. These tools aid the researchers to collect authentic data and arrive at a definite conclusion. The prevailing competitors in the global Medical Nasogastric Tubes Market has also been portrayed in the report, offering an opportunity to the market players to gauge their performance.

Get discount on this report @ https://qualiketresearch.com/request-sample/Medical-Nasogastric-Tubes-Market/ask-for-discount

Increase in demand for nasogastric tubes due rise in incidences of chronic diseases considered as key driving factor which is expected to boost the global medical nasogastric tubes market growth. Furthermore, increase in number of malnutrition patients across the world is one of the significant factors will positively contribute the market growth. For instance, as per the WHO (World Health Organization) report 2017, around 2mn people across the world lack key micronutrients such as vitamins. As per the survey 40% of hospitalized patients are suffering from malnutrition that has increased the mortality and morbidity rate. Thus, nasogastric tubes are the first choice to suffice the adequate amount of nutrients in malnourished and those who are unable to take nutrients orally.

However, infections and skin irritation caused by nasogastric procedures due to improper sterilization is the major restraining factor which is expected to hinder the global medical nasogastric tubes market growth during this analysis period.

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Market Segmentation

Global Medical Nasogastric Tubes Market is segmented into type such as Levin Catheter, Dobhoff Tube, Sengstaken- Blakemore Tube, and Others, by patient such as Pediatric, and Adult. Further, market is segmented into end use such as Hospitals, Clinics, and Others.

Also, Global Medical Nasogastric Tubes Market is segmented into five regions such as North America, Latin America, Europe, Asia Pacific, and Middle East & Africa.

Market Key Players

Various key players are discussed into this report Degania Medical, Guangdong Baihe Medical Technology, Bicakcilar, Bard Medical,  Pacific Hospital Supply Co. Ltd, Andersen Products, Cardinal Health, Cook Medical, Rontis Medical,and Poly Medicure Limited

Read Related Report @ https://bisouv.com/uncategorized/3692063/covid-19-impact-on-global-pharmaceutical-packaging-equipment-market-2020-future-development-manufacturers-trends-share-size-and-forecast-shared-in-the-report/

About Us

QualiKet Research is a leading Market Research and Competitive Intelligence partner helping leaders across the world to develop robust strategy and stay ahead for evolution by providing actionable insights about ever changing market scenario, competition and customers. QualiKet Research is dedicated to enhancing the ability of faster decision making by providing timely and scalable intelligence. We use different intelligence tools to come up with evidence that showcases the threats and opportunities which helps our clients outperform their competition.

[minimalmillennial]

1.28.17 We spent 9 hours in static lab today learning Intramuscular injections, intradermal injections, subcutaneous injections, how to give Lovenox injections, using a carpujet, how to break the glass and draw up medication, how-to draw up multiple types of insulin in one syringe, how to administer PO medications using the 3-step check, how to insert and remove a nasogastric tube, how to take care of a dobhoff, tube feedings through a gastric tube using a kangaroo pump, giving liquid and crushed medications through a gastric tube, and oral feeding for disabled patients. Needless to say it was one of the longest days of my life and my brain is mush now but also I learned I love giving injections!

[mcatmemoranda]

There are different brands of feeding tube but usually only one brand is used at any one hospital. A common brand is called a Dobhoff tube. This is a trademarked name but this term is often used generically for any feeding tubes that have weighted tips. These tips will appear as a linear metallic density and are designed to allow peristalsis to carry the tubes through the pylorus to the duodenum. Ideally, they should end up in the third portion of the duodenum or duodenal-jejunal junction.

Clinical hint: Place the patient on their right side when trying to advance the tube through the pylorus. This makes the weight of the tube fall against the pylorus. If all else fails, it can be done in radiology under fluoroscopic control.

Other tubes and wires

Checking that all lines, tubes, and wires are correctly placed is vital. You would be surprised at where some of these lines end up. For example, central venous catheters are notorious for following tiny veins, such as along the pericardium. This can be a problem if you are infusing an irritating substance. It is important that you have a basic understanding of normal central line placement as well as incorrect line placements. Resources on how to assess for correct line and tube positions:

Learningradiology

The chart about is from the Learningradiology site. SVC = Superior Vena Cava.

AAMC Lines and Tubes Radiology Learning Module

[mynameisbiru]

One actual seizure.  A family who keeps hitting me with the most helpless looks when they keep seeing the same thing every time, when there’s nothing really I can do.  ‘Cause no way in hell would I ever hit anyone with 2mg of IV Ativan when the neurologists don’t see any actual seizure waveforms.

Another guy not getting his platelets until hours later ‘cause the hospital delivery of blood products not showing up until the afternoon.  Same guy pulling out his Dobhoff and needing to get a resident to come up and see him so we can drop another one.  Then delaying the platelets because the blood consent in the chart wasn’t done properly.  THEN the level of time consumption of actually infusing the platelets.

Like shit.  My 1:1 suicide watch patient was the easiest least complicated person I had, more or less.

[baggettsathome]

Real Food!

It’s been nearly a week since our last update, and we’re happy to report some actual forward progress (along with a lateral move or two).

Toward the end of last week, Nate’s dobhoff (feeding) tube was not cooperating. Each time we tried to increase the rate to give him additional nutrition, he got nauseated or bloated and they were forced to back things down again. On Friday, the feeding pump kept alarming that the tube was clogged and they had to turn it off completely. But on Saturday morning, the surgeons came in with a surprise announcement: Nate can eat!

Nate hadn’t eaten solid food for 47 days and spent most of that time craving a taco. The hospital low-fat diet chicken taco wasn’t exactly what he was daydreaming of but it’s progress!

He started with a few goldfish crackers and a couple of bites of a chicken taco. He’s still limited to a low-fat diet and he’s taking thing very, very slowly. But he’s eaten a little bit more each day since and it’s gone well. No nausea or new pain or bloating.

But the dobhoff issues still needed addressing because he’s not taking in enough calories to meet all his body’s needs yet. Yesterday (Monday), they prepared to take him down to interventional radiology to try repositioning the tube. Before that, they also did a CT scan to see if they could make sense of some changing drainage near his bile drain.

Unfortunately, the CT scan showed a few new fluid collections that all needed to come out. Along with repositioning the feeding tube, Nate’s trip to IR was extended to include putting in more drains. In the end, he ended up with one net new drain. One previous drain was removed and two new ones were added. He’s now has his bile drain + four JP (smaller, bulb-shaped) drains. One of the fluid collections was too small and too hard to reach this time, so they plan to do another CT on Thursday to look again. If the collection is still growing, they’ll be able to reach it to drain. If it’s getting smaller, they’ll leave it alone.

Visitors from near and far have made the last week a little brighter.

Like all the other fluid that’s come out of his belly, this fluid is growing some nasty bugs. However, there isn’t anything new or unexpected so, for now at least, the infectious disease team thinks his current antibiotic regimen should have him covered.

After that adjustment, the dobhoff seems to be working much better. Between that and the small amounts he’s actually eating, the team felt comfortable pulling him off the IV nutrition. It’ll be the first time in over a month that Nate’s not hooked up to that all night. IV nutrition can also negatively affect the liver, so we’re also hoping that stopping it will help correct the last two of Nate’s liver labs still in the abnormal range.

For most of October, our situation felt precarious and we were focused on getting through each day. For the first time in a while, we’re looking more at the future and what milestones we hope lie ahead. Eventually, Nate will be eating enough that he doesn’t need the tube feeding anymore and they can pull it out. (Nate is very hopeful this is soon.) At some point, they’ll do a capping trial of his bile drain. With that, they close the drain off temporarily to make sure that the leak doesn’t show itself again with bile in his drains. If that capping trial goes well, they can begin to think about pulling the bile drain out. Another thing in the back of our minds is that the stent that was placed in Nate’s pancreas way back in September also needs to be either replaced or removed at some point soon.

Thursday marks Nate’s 61st day in this hospital this admission and 200th day in the hospital since his first transplant in March 2017. But our spirits are fairly high. Being able to eat real food was a huge step and although the new drains were kind of a bummer, it was more of a lateral step than backwards one.

Thankful that a few of the Baggett cousins could make a detour to visit Madison on their road trip!

Our moods were also probably helped by our lovely visitors over the weekend and the little gifts they brought us, which we learned several of you out there contributed to! We have enjoyed opening the four little jars of notes and reading some of your favorite memories with us, things to make us laugh, and things to lift us up. (If you haven’t sent in a message yet, we’re still accepting them! Check this out.)

Incredible friends who coordinated making these jars of happy notes and wrote out everyone’s responses for us.

And beyond the well wishes we’ve received from you all, we also received a few surprise bits of encouragement from some totally unexpected sources. Thanks to our friend Allie who used her connections to get these videos (which we’ve been showing to almost everyone who comes by Nate’s room):

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Kyle Hendricks (Chicago Cubs Pitcher)

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Wilson Contreras (Chicago Cubs Catcher)

[jadhavsweety]

Global Medical Nasogastric Tubes Market Outlook, Opportunity, Development,Top Key Players Analysis,Demand  And Forecast 2020 – 2027

Nasogastric tube is passed by means of the nose and down through the nasopharynx and throat into the stomach. It is an adaptable tube made of plastic and elastic and it has bidirectional potential. Insertion of an organic tube, helps gaining access to stomach and its contents. These tubes are used for are suitable for enteral feeding up to six weeks.

Increase in demand for nasogastric tubes due rise in incidences of chronic diseases considered as key driving factor which is expected to boost the global medical nasogastric tubes market growth. Furthermore, increase in number of malnutrition patients across the world is one of the significant factors will positively contribute the market growth. For instance, as per the WHO (World Health Organization) report 2017, around 2mn people across the world lack key micronutrients such as vitamins. As per the survey 40% of hospitalized patients are suffering from malnutrition that has increased the mortality and morbidity rate. Thus, nasogastric tubes are the first choice to suffice the adequate amount of nutrients in malnourished and those who are unable to take nutrients orally.

Get Sample Copy of this Report @ https://qualiketresearch.com/request-sample/Medical-Nasogastric-Tubes-Market/request-sample

However, infections and skin irritation caused by nasogastric procedures due to improper sterilization is the major restraining factor which is expected to hinder the global medical nasogastric tubes market growth during this analysis period.

Market Segmentation

Global Medical Nasogastric Tubes Market is segmented into type such as Levin Catheter, Dobhoff Tube, Sengstaken- Blakemore Tube, and Others, by patient such as Pediatric, and Adult. Further, market is segmented into end use such as Hospitals, Clinics, and Others.

Also, Global Medical Nasogastric Tubes Market is segmented into five regions such as North America, Latin America, Europe, Asia Pacific, and Middle East & Africa.

Market Key Players

Various key players are discussed into this report Degania Medical, Guangdong Baihe Medical Technology, Bicakcilar, Bard Medical,  Pacific Hospital Supply Co. Ltd, Andersen Products, Cardinal Health, Cook Medical, Rontis Medical,and Poly Medicure Limited

Market Taxonomy

By Type

Levin     Catheter

Dobhoff     Tube

Sengstaken-     Blakemore Tube

Others

By Patient

Pediatric

Adult

By End user

Hospitals

Clinics

Others

By Region

North     America

Latin     America

Europe

Asia     Pacific

Middle     East & Africa

Browse Full Research Report @ https://qualiketresearch.com/reports-details/Medical-Nasogastric-Tubes-Market

About Us

QualiKet Research is a leading Market Research and Competitive Intelligence partner helping leaders across the world to develop robust strategy and stay ahead for evolution by providing actionable insights about ever changing market scenario, competition and customers. QualiKet Research is dedicated to enhancing the ability of faster decision making by providing timely and scalable intelligence. We use different intelligence tools to come up with evidence that showcases the threats and opportunities which helps our clients outperform their competition. 

[mcatmemoranda]

This is from the Core Clerkships app. Thought I already posted it.

[mcatmemoranda]

This is a NG tube that is used to provide nutrition rather than remove GI contents. A Dobhoff must be placed past the pylorus and should terminate in the 2nd or 3rd part of the duodenum as to prevent aspiration of feeds. X-ray must confirm position before feeds can be administered.

A Dobhoff tube is different from a regular nasogastric tube. From radiopaedia:

Dobhoff tube is a special type of nasogastric tube (NGT), which is a small-bore and flexible so it is more comfortable for the patient than the usual NGT. The tube is inserted by the use of a guide wire called the stylet...

NG tubes go into the stomach whereas Dobhoff tubes go beyond the stomach into the small intestine.

[baggettsathome]

Drains, drains, drains

We didn’t keep the weekend as boring as we would have liked, unfortunately. Nate’s been down to interventional radiology twice more since our last post, and he’s there now too. He has several more tubes/drains than he did a few days ago.

Hanging out in the cheerier Children’s Hospital lobby on Saturday before learning Nate had to go down to IR again.

--- A Quick Word About Drains... So... why all the drains? The purpose of a drain is to keep fluid from building up in the abdomen. That fluid, whether blood or pancreatic enzymes or something else, can disrupt healing either by becoming infected or just getting in the way. Getting that fluid out of the body completely makes it easier for the body to heal. The drains can also give doctors and nurses a look into the abdomen. A change in a drain’s output in terms of volume or color or consistency can be signal of what’s happening within Nate’s belly. ---

On Saturday afternoon, two of Nate’s drains tested positive for bilirubin, meaning they contained bile. That’s a sign that there’s a leak somewhere along his bile duct, which drains from the liver into the small intestine. That means another drain to divert the bile away from where it’s leaking. The goal is that without bile flowing over the leak, it will be able to seal itself up and heal.

The last two times Nate has had a bile drain (called a “PTC”), it was bad news. The drains themselves were really painful and the liver they drained ultimately failed both times. The surgeons acknowledged that rocky history. But they also said that Nate’s liver this time is still working well, not rejecting, and that this leak is yet another side effect of that pancreatic fluid eating away at stuff. The surgeons talked to us for quite a while about this latest setback, which we really appreciated. It’s definitely that, a setback. But the surgeons still feel strongly that the leaks, all of them, can be resolved... it’s just that getting to that point is likely to well, suck and take a long time.

The definite bright spot of the weekend was a visit from our little cousins from Iowa! They did great at the hospital, playing some games with us, learning all about Nate’s wound vac, and even putting up some cheery Halloween decorations in Nate’s room.

When IR placed the new drain, they also placed a feeding tube. The tube -called a dobhoff - goes into Nate’s nose into his GI tract down past his pancreas, that way we can feed his gut without that angry pancreas having to get involved. Getting nutrition right to his gut rather than an IV in his arm should mean that more nutrients and calories are absorbed into the body. And everyone is hoping that some better nutrition will aid the healing process and just get these stupid leaks healed. Over the next week, they’ll start feeding Nate through that tube and weaning him off the IV nutrition.

The good news about the bile drain is that it seems to be doing exactly what it’s meant to: the drains that had bile in them on Saturday have been putting out drastically less fluid now. It’s also placed in a spot we’re hopeful will be less painful, under the ribs instead of between them. The bad news is that they had a really hard time getting the tube into his liver for the PTC drain yesterday. They think that as they were entering the liver, a little abscess cavity formed near the site and filled with bile. Some of that bile has been leaking out through his skin and they definitely don’t want it leaking anywhere else inside his abdomen. So they need to go in a put a tube in that abscess to drain it now too. That’ll be drain #7.  

The bile leak is, like the pancreatic leaks, so small that it wasn’t visible on a scan. But, again like the pancreatic leaks, we know it’s there and we know it will cause serious issues if not resolved.

Otherwise, his blood cultures are still clean, and the ID team is satisfied with how things are looking from their perspective. His liver numbers ticked up today and he’s had a low-grade fever overnight, which is expected after a procedure. Nate is continuing to focus on the things that he’s able to control. He’s walked every day since getting back up to the transplant floor and is working on PT and OT even on the days when he feels crummy and down in the dumps (like today).

Now with a feeding tube + a bile drain. Doing squats, leg lifts, arm exercises, and walks every day is going to make Nate’s long-term recovery better, helping him avoid losing more muscle mass.