Confirmation of correct placement of nasogastric / orogastric tube on Point of Care Ultrasound (POCUS) in pediatric critical care unit patients.

Abstract

Objective: To determine frequency of correct placement of nasogastric /orogastric tube on POCUS in pediatric critical care unit patients. Study Design: Descriptive cross-sectional. Setting: High Dependency Unit and Pediatric Intensive Care Unit, Indus Hospital Health Network, Karachi, Pakistan. Period: November 2022 to April 2023. Methods: Patients of age 1 months to 15 years of age requiring NGT placement were enrolled into the study. Patients with nasal surgery, fracture of skull base/ face, bleeding, coagulopathy, esophageal varices, stricture, upper gastrointestinal surgery were excluded from this study. NG tube was passed by principal investigator after evaluating correct size and length measurement. After passing the NG tube, gastric aspiration and gastric auscultation were also performed by principal investigator. Results: In this study we enrolled 147children with median age of patient was 3 (IQR=0.75-07) years. Majority of patient in our study were male (63.9%). Gastric aspiration and gastric auscultation was seen in all of the study patients. Based on POCUS, frequency of correct placement of nasogastric tube in children admitted in PICU was 83%. Sensitivity of POCUS against gastric aspiration and gastric auscultation was 82.5% with 100% positive predictive value (PPV). Specificity was unable compute as there was no negative finding in reference standard and hence there was also no false positive case. Conclusion: POCUS seems to be helpful and could help with the placement of NGT in paediatric clinical settings. Nevertheless, NGT envision in the stomach was difficult, and if the operator is not skilled or there is abdominal distention, it may go unnoticed.