Text reads: HomeGrown Solutions, HomeGrown Simulation Solutions, an initiative of INACSL, powered by the N L N S I R C.

HomeGrown Solution: Simulating Dobhoff or Nasogastric Tube Placement in a High-Fidelity Manikin

Title

Simulating Dobhoff or Nasogastric Tube Placement in a High-Fidelity Manikin

Submitted By

Latisha Beasley

HomeGrown Solution Number

399

Identification of the Problem

Many high-fidelity manikins lack functionality for inserting Dobhoff or NG tubes. When inserting a Dobhoff or nasogastric (NG) tube in the nares of high-fidelity manikins, such as a Gaumard Hal simulator, the tracheal sensor is triggered for intubation, and the manikin goes into CPR mode. An innovative solution that will not compromise the manikin's functionality but will allow for Dobhoff or NG tube placement has been developed to address this limitation and enhance realism and fidelity during simulation or training activities.

Unique Idea

This creative and cost-effective solution was born from faculty concerns regarding learners’ ability to effectively manage clients (patients) with Dobhoff or NG tubes. Without proper recognition of Dobhoff or NG tube management, learners risk missing critical aspects of patient care, such as reassuring clients, understanding procedures, and identifying potential complications. To overcome this issue, a simulation scenario was developed, followed by brainstorming to devise a realistic way to insert a Dobhoff or NG tube in a high-fidelity manikin without activating the intubation sensor. The Dobhoff or NG tube management simulation was brought to life after realizing all necessary supplies were available in the lab. The result was an engaging, hands-on experience that allowed learners to practice properly caring for clients with nasogastric tubes.


The goal is to ensure learners can accurately recognize placement, maintain, and/or feed clients using a Dobhoff or NG tubes.

Objectives

  1. Design a low-cost, realistic solution to simulate a client with a Dobhoff or NG tube.

  1. Design a low-cost, realistic solution that helps learners identify complications associated with Dobhoff or NG tubes and communicate effectively when managing care for patients receiving tube feedings.

  1. Design a low-cost, realistic method to safely and accurately implement Dobhoff or NG tube feeding orders following proper placement confirmation.

Supplies/Ingredients

  • high-fidelity client simulator on a stretcher or hospital bed
  • one 8 Fr Dobhoff or 14 Fr Salem sump NG tube
  • endotracheal tube size 6 mm or 6.5 mm
  • mineral oil (per manufacturer recommendation)
  • manikin
  • tape to secure the tube
  • gloves
  • towel
  • extra trachea skin flap

Steps to Create the Solution

1. After collecting all necessary supplies, elevate the bed to a comfortable working height, don gloves, and remove the trachea from the manikin.

2. Obtain the endotracheal tube (ET), detach the tube holder from the top of the ET tube, and apply mineral oil to the tip of the ET tube for lubrication. 

3. Insert the Dobhoff or nasogastric (NG) tube into the ET tube until it reaches the end of the ET tube.

4. Carefully insert the ET tube, with the Dobhoff or NG tube still inserted, into the manikin’s nasal passage until it emerges from the trachea.

5. Adjust the Dobhoff or NG tube so that it extends about halfway through the ET tube to prevent it from accidentally coming out.

6. Once the Dobhoff or NG tube is correctly positioned, remove the ET tube, leaving the Dobhoff or NG tube in place. 

7. Position the Dobhoff or NG tube at the proper length, then lift the manikin’s chest or shoulder skin and gently tuck the remaining portion of the tube underneath the skin, clothing, or pillow, ensuring the stylet remains unbent. At this point, you can add a drainage bag of choice.

8. Replace the manikin’s skin flap over the trachea, using cotton balls, tissue, or small paper towels to fill any gaps if necessary.

9.Secure the Dobhoff or NG tube at the nare with manikin tape or another preferred securing device. If using a Dobhoff, remove the stylet; now you are ready to use the Dobhoff or NG tube for your simulation activity.

Images

Table with a box of gloves, a bottle of mineral oil, a roll of tape, an NG tube, an endotracheal tube and a towel. Manikin with with a visible tracheal opening in its neck. The manikin has brown skin, open eyes and mouth, and is positioned on a hospital bed. Manikin with a nasogastric tube inserted through its nare and a tracheostomy tube in its neck. The manikin has brown skin and is lying on a hospital bed. Manikin with Dobhoff inserted through ET tube for placement. The manikin has brown skin and is lying on a hospital bed. Close-up of a brown-skinned manikin lying on a white pillow. A nasogastric tube is inserted through its nose and secured with tape. The manikin's eyes are open and its mouth is slightly ajar.

Video

<

HomeGrown Disclaimer

The information contained within this website is for information purposes only. While the website is monitored in an attempt to keep the information up to date and accurate, be aware that there are no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, and/or suitability being made. The sponsors of this website are not liable for any loss or damage that may result from using information contained within this website. Any reliance you place on the information contained within this website is strictly at your own risk.

Please note that sections of this website include postings of individuals not associated with the website sponsors. These postings are not endorsed or warrantied by the website, and use of such information is at your own risk.

Always check the user guide/manuals provided by the manufacturer of your manikin or task trainer. Using products that are not sanctioned may invalidate the product warranty. (For example: Some products could stain the skin on a manikin. Liquids used around electrical parts may cause malfunctions.)