The evaluation of efficacy of three different ultrasonography methods for verification of gastric tube placement in intensive care unit patients

Gastric tube (GT) placement is a routine procedure in critically ill patients. Improper placement of GT could lead to severe complications. Radiography remains as the gold standard test to confirm tube position. The study aim is to estimate diagnostic accuracy of three different ultrasonography (USG) methods to verify GT placement in intensive care units (ICU). Twenty-five mechanically ventilated patients were included in this prospective and observational study. All real time US examinations were performed by an intensivist in three steps: sonography ofneck for visualizing esophagus and upper abdominal quadrant for visualizing stomach, and visualisation of dynamic fogging during water and air insufflations in gastric area. Finally, gastric placement of GT was confirmed with abdominal radiography. USG visualized GT in esophagus in 24 (96 %) patients. GT was directly visualized in stomach in 16 (64%) patients and dynamic fogging occurred in 20 (80 %) in the first attempt and in 23 (92 %) patients after tube removal. Because gastric tube was not seen in stomach in nine cases, dynamic fogging allowed to confirm intragastric position in seven cases. In two cases, no dynamic fogging was observed, and radiography confirmedtube malposition in esophagus. Entire sonographic procedure took 7.24±2.58 minutes. Visualization of the esophagus and dynamic fogging improves the diagnostic accuracy of USG in verifying GT position. Confirming correct GT placement by USG has the potential to reduce X-ray usage and save time. However, X-ray remains the gold standard in cases in which USG cannot verify placement of the GT

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1. Pillai JB, Vegas A, Brister S. Thoracic complications of nasogastric tube: review of safe practice. Interact Cardiovasc Thorac Surg. 2005;4(5):429-33.

2. Miller KS, Tomlinson JR, Sahn SA. Pleuropulmonary complications of enteral tube feedings. Two reports, review of the literature, and recommendations feedings. Chest. 1985;88(2):230-3.

3. Sorokin R, Gottlieb JE. Enhancing patient safety during feeding-tube insertion: a review of more than 2000 insertions. JPEN J Parenter Enteral Nutr. 2006;30(5):440-5.

4. Roubenoff R, Ravich WJ. Pneumothorax due to nazogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention. Arch Intern Med. 1989;149(1):184-8.

5. Harris MR, Huseby JS. Pulmonary complications from nasoenteral feeding tube insertion in an intensive care unit: incidence and prevention. Crit Care Med. 1989; 17(9):917-9.

6. Metheny N, Williams P, Wiersema L, Wehrle MA, Eisenberg P, McSweeney M. Effectiveness of pH measurements in predicting feed tube placement. Nurs Res. 1989;38(5):280-5.

7. Metheny N, McSweeney M, Wehrle MA, Wiersema L. Effectiveness of the auscultatory method in predicting feeding tube location. Nurs Res. 1990;39(5):262-7.

8. Kindopp AS, Drover JW, Heyland DK. Capnography confirms correct feeding tube placement in intensive care unit patients. Can J Anesth. 2001;48(7):705-10.

9. Fernandez RS, Chau JP, Thompson DR, Griffiths R, Lo HS. Accuracy of biochemical markers for predicting nasogastric tube placement in adults-A systematic review of diagnostic studies. Int J Nurs Stud. 2010;47(8):1037-46.

10. Neumann MJ, Meyer CT, Dutton JL, Smith R. Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995;20(4):293-5.

11. Hernandez-Socorro CR, Marin J, Ruiz-Santana S, Santana S, Manzano JL. Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients. Crit Care Med. 1996;24(10):1690-4.

12. Lock G, Reng CM, Köllinger M, Rogler G, Schölmerich J, Schlottmann K. Sonographische Kontrolle von Magensonden bei Intensivpatienten. Intensivmed. 2003;40(8):693-7.

13. Vigneau C, Baudel JL, Guidet B, Offenstadt G, Maury E. Sonography as an alternative to radiography for nasogastric feeding tube location. Intensive Care Med. 2005;31(11):1570-2.

14. Chenaitia H, Brun PM, Querellou E, Leyral J, Bessereau J, Aime`C, Bouaziz R, Georges A, Louis F. Ultrasound to confirm gastric tube placement in prehospital management. Resuscitation. 2012;83(4):447-51.

15. Brun PM, Chenaitia H, Lablanche C, Pradel AL, Deniel C, Bessereau J, Melaine R. 2-point ultrasonography to confirm correct position of the gastric tube in prehospital setting. Mil Med. 2014;179(9):959-63.

16. Zatelli M, Vezzali N. 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients. J Ultrasound. 2016;20(1):53-8.

17. Kim HM, So BH, Jeong WJ, Choi SM, Park KN. The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency centre. Scand J Trauma Resusc Emerg Med. 2012;20:38-44.

18. Wong KW, Chan HH, Wong CP, Chan MY, Chau JC, Wong TW. Using color flow detection of air insufflation to improve accuracy in verifying nasogastric tube position. Am J Emerg Med. 2017;35(2):333-6.

19. Gok F, Kilicaslan A, Yosunkaya A. Ultrasound-guided nasogastric feeding tube placement in critical care patients. Nutr Clin Pract. 2015;30(2):257-60.

20. Galbois A, Vitry P, Ait-Oufella H, Baudel JL, Guidet B, Maury E, Offenstadt G. Colorimetric capnography, a new procedure to ensure correct feeding tube placement in the intensive care unit: an evaluation of a local protocol. J Crit Care. 2011;26(4):411-4.

21. Law RL, Pullybank AM, Eveleigh M, Slack N. Avoiding never events: improving nasogastric intubation practice and standards. Clin Radiol. 2013;68(3):239-44.

22. Taylor SJ. Confirming nasogastric feeding tube position versus the need to feed. Intensive Crit Care Nurs. 2013;29(2):59-69.