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Ultrasound is safe and highly specific for confirmation of proper gastrostomy tube replacement in pediatric patients

  • Author Footnotes
    1 Present address: Pediatric Emergency Medicine, Denver Health, Emergency Ultrasound Fellow, University of Colorado, Anschutz School of Medicine, 601 N Broadway, Sixth Floor, Department of Emergency Medicine, Denver, CO 80203.
    Cailin Frank
    Correspondence
    Corresponding author at: Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States
    Footnotes
    1 Present address: Pediatric Emergency Medicine, Denver Health, Emergency Ultrasound Fellow, University of Colorado, Anschutz School of Medicine, 601 N Broadway, Sixth Floor, Department of Emergency Medicine, Denver, CO 80203.
    Affiliations
    Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States

    University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States
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  • Regan F. Williams
    Affiliations
    University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States

    Division of Pediatric Surgery, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States
    Search for articles by this author
  • Thomas Boulden
    Affiliations
    University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States

    Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States
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  • Rudy Kink
    Affiliations
    Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States

    University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States
    Search for articles by this author
  • Elizabeth A. Paton
    Affiliations
    Division of Pediatric Surgery, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States

    College of Nursing, University of Tennessee Health Science Center, 874 Union Ave, Memphis, TN 38103, United States
    Search for articles by this author
  • Author Footnotes
    1 Present address: Pediatric Emergency Medicine, Denver Health, Emergency Ultrasound Fellow, University of Colorado, Anschutz School of Medicine, 601 N Broadway, Sixth Floor, Department of Emergency Medicine, Denver, CO 80203.

      Highlights

      • What patients are at highest risk of complications from GT dislodgement?
      • Postoperative patients and those who require stoma dilation are more likely to have complications during emergent replacement.
      • What is the best way to confirm proper GT placement?
      • Contrast injection is the current standard of care.
      • Ultrasound is both a safe and highly specific confirmatory test when used to confirm gastrostomy placement.

      Abstract

      Background

      Gastrostomy tube (GT) dislodgement is a common cause of Pediatric Emergency Department (PED) visits. Postoperative patients and those who require stoma dilation are more likely to have complications during emergent replacement. Although incorrect replacement can cause significant morbidity overall, the occurrence is infrequent. Contrast injection of the GT is considered the standard for confirming proper placement. Case reports in both pediatric and adult patients suggest that ultrasound can be used to confirm proper replacement. The objective of the present study was to assess the utility of ultrasound to confirm GT placement in pediatric patients most at risk for complications from incorrect replacement.

      Methods

      This is a non-randomized cohort pilot trial to determine the sensitivity and specificity of ultrasound to confirm proper replacement of a GT in a Pediatric Emergency Department.

      Results

      We enrolled 55 pediatric subjects, of which 50 had ultrasound imaging after GT replacement in the PED prior to contrast injection. Ultrasound was found to have 96% sensitivity and 100% specificity for confirming GT placement.

      Conclusions

      Ultrasound is a safe and reliable confirmatory study to confirm GT placement in pediatric patients, especially those at highest risk of complications from incorrect placement.

      Level of evidence

      II

      Keywords

      Abbreviations:

      GT (Gastrostomy tube), LOS (Length of stay), PED (Pediatric emergency department), PEM (Pediatric emergency medicine), POCUS (Point-of-care-ultrasound), US (Ultrasound)
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