Evaluation of nasogastric tube location using point-of-care ultrasonography in paediatric patients.

Abstract

Background: Nasogastric tubes (NGTs) are used in children emergency departments (EDs) for gastric decompression, as well as for enteral nutrition and drug administration in hospitalised patients. Radiography is considered the gold standard for determining NGT location and may require repeat films until the tube is appropriately positioned. Point-of-care ultrasonography (POCUS) could potentially be useful in avoiding radiation in these children.

Methods: Between September 2022 and February 2023, patients aged 0-18 years who presented to the Gazi University Faculty of Medicine Paediatric ED in Turkey and received NGTs were eligible for the study and included when our paediatric emergency physician certified in POCUS was present. The operation used a convex probe in B-mode to visualise the NGT tip as a hyperechoic line in the stomach. If not visualised, the air was injected through the tube to look for an air artefact on ultrasound. Radiographs were subsequently performed and interpreted by the treating ED physician, blinded to POCUS findings. The accuracy of POCUS was determined using radiography as a reference standard.

Results: Twenty (13 boys) children were included in the study. The median age of the patients was 20 (IQR 9-108) months. 16 patients had underlying chronic neurological and metabolic diseases or congenital anomalies. Of the 20 NGTs, radiography detected 18 in the stomach. POCUS confirmed the NGT in the stomach for 15 of these patients by visualising the tip or air artefact. When radiography located the NGT in the oesophagus in two patients, POCUS was negative. The resulting test characteristics were as follows: sensitivity was 83% (95% CI 59% to 96%), specificity 100% (95% CI 16% to 100%), negative predictive value 40% (95% CI 19% to 65%), positive predictive value 100% (95% CI 78% to 100%) and accuracy 85% (95% CI 62% to 97%).

Conclusion: POCUS may be an alternative method to radiography to confirm the location of the NGT in children. However, studies with a broader patient population are needed.