A 58 year old female with a history of end stage renal disease on hemodialysis, insulin dependent diabetes mellitus, ischemic cardiomyopathy, and adrenal insufficiency, presented from home with altered mental status and hypotension. She developed refractory hypotension requiring vasopressors and was admitted to the medical ICU for management of septic shock due to bacterial peritonitis. She was intubated and had an oro-gastric tube placed for enteral nutrition. However, significantly elevated gastric residuals developed secondary to delayed gastric emptying. We decided to place a post-pyloric Dobhoff tube as an alternative gastric access to continue enteral feeding. Since a Cortrak machine (an electromagnetic-guided enteral access system) was unavailable, we used a two-step approach with a portable chest x-ray to assess accurate and safe placement.