Ultrasound to confirm gastric tube placement in prehospital management

Chenaitia, Hichem; Brun, Pierre-Marie; Querellou, Emgan; Leyral, J.; Bessereau, Jacques; Aimé, Christine; Bouaziz, R.; Georges, Arnaud; Louis, Fabrice

doi:10.1016/j.resuscitation.2011.11.035

Cited by 56 publications

(67 citation statements)

References 13 publications

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“…In emergency room patients with low consciousness, aspiration of the gastric contents (even in patients with a nasogastric tube in place) was frequently impossible due to either bag-valve-mask ventilation during intubation or the presence of large amounts of gastric air in patients with intestinal obstruction or paralytic intestinal adhesion. Also, Some study also reported that the pH method was inappropriate for distinguishing tube placement within the bronchial tubes or the small intestine in patients with reduced gastric acidity [13,14]. In this study, the complete history of the patients’ use of medications, such as H2 blockers, was not known.…”

Section: Discussionmentioning

confidence: 88%

The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

Kim

Jeong

et al. 2012

Scand J Trauma Resusc Emerg Med

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BackgroundThis study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion.MethodsThe study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 ± 17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination.ResultsThe sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%.ConclusionsUltrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.

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Section: Discussionmentioning

confidence: 88%

The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

Kim

Jeong

et al. 2012

Scand J Trauma Resusc Emerg Med

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“…Cheinata et al confirmed the position of GT in gastric region at the rate of 89% (n=130) through the direct monitoring [14]. In a study performed in 132 patients by Brun et al (2014), the position of GT was confirmed in esophagus in 100% of all patients and in stomach in 62.5% through USG.…”

Section: Discussionmentioning

confidence: 93%

“…However, radiography is associated with undesirable factors, such as exposure to ionizing radiation, cost and time-consuming [9,10]. In recent years, increasing number of studies have examined the efficacy of USG as an alternative to radiography for confirming the position of GT [11][12][13][14][15][16][17]. However, there are controversial and conflicting results on diagnostic accuracy, and there is no consensus on the role of USG in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…However, there are controversial and conflicting results on diagnostic accuracy, and there is no consensus on the role of USG in routine clinical practice. In addition, direct visualization of stomach as a definitive verification method can be difficult due to interposition, gastric content and patients' characteristics (obese or excessively mobile) [11][12][13][14]. Therefore, additional methods, such as combining different scanning points and visualization of dynamic fogging or Doppler signal due to air insufflation can be used to improve the accuracy of diagnosis [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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

Gök¹

2017

Med-Science

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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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“…The use of abdominal ultrasonography to verify GT placement has been shown to be a useful and effective technique in adults with high sensitivity and specificity; attaining 98.3 and 100%, respectively, when compared with the results of conventional radiological examination 33 . Its use in verifying the location of the end of the GT has been recommended in adult patients instead of radiological examination since it is a simple and fast technique, in addition to the advantage of not exposing the patient to radiation 34 - 35 .…”

Section: Discussionmentioning

confidence: 99%

Procedures for measuring and verifying gastric tube placement in newborns: an integrative review

Dias

Emídio

Lopes

et al. 2017

Rev. Latino-Am. Enfermagem

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Objective:to investigate evidence in the literature on procedures for measuring gastric tube insertion in newborns and verifying its placement, using alternative procedures to radiological examination. Method:an integrative review of the literature carried out in the Cochrane, LILACS, CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors “Intubation, gastrointestinal” and “newborns” in original articles. Results:seventeen publications were included and categorized as “measuring method” or “technique for verifying placement”. Regarding measuring methods, the measurements of two morphological distances and the application of two formulas, one based on weight and another based on height, were found. Regarding the techniques for assessing placement, the following were found: electromagnetic tracing, diaphragm electrical activity, CO2 detection, indigo carmine solution, epigastrium auscultation, gastric secretion aspiration, color inspection, and evaluation of pH, enzymes and bilirubin. Conclusion:the measuring method using nose to earlobe to a point midway between the xiphoid process and the umbilicus measurement presents the best evidence. Equations based on weight and height need to be experimentally tested. The return of secretion into the tube aspiration, color assessment and secretion pH are reliable indicators to identify gastric tube placement, and are the currently indicated techniques.

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Ultrasound to confirm gastric tube placement in prehospital management

Cited by 56 publications

References 13 publications

The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

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

Procedures for measuring and verifying gastric tube placement in newborns: an integrative review

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