Ultrasound can accurately guide gastrostomy tube replacement and confirm proper tube placement at the bedside.
J Emerg Med
; 36(3): 280-4, 2009 Apr.
Article
em En
| MEDLINE
| ID: mdl-18614327
ABSTRACT
BACKGROUND:
Malfunctioning or dislodged gastrostomy tubes (G-tubes) often require urgent replacement and reinsertion in the Emergency Department (ED). Few data exist regarding the best technique for bedside catheter replacement and verification, and individual operator preferences vary. Although a few reports have described the use of ultrasound guidance during the initial percutaneous insertion, no data are available concerning its role during subsequent G-tube replacements.OBJECTIVE:
We sought to investigate the utility of bedside ultrasonography during G-tube replacements in the ED.METHODS:
This was a prospective pilot study conducted at a Level 1 Trauma Center with an annual census of 90,000 patients. Seven adults and three children with malfunctioning G-tubes were enrolled. Three tubes were cracked and leaking, and seven tubes had been dislodged. Under ultrasound, a new G-tube was inserted through the previously fashioned tract. After insertion, color Doppler was applied over the catheter tip to enhance visualization during gentle tube oscillation.RESULTS:
Ultrasound successfully visualized G-tube replacement in all 10 patients. Application of color Doppler over the G-tube tip during catheter oscillation enhanced placement confirmation. Sonographic findings were corroborated with gastric content aspiration, contrast-enhanced radiographs, and successful use of the new G-tubes. No false tracts were identified during ultrasound-guided insertion, post-procedure sonographic confirmation, or subsequent radiographs.CONCLUSION:
The improper replacement of a G-tube can lead to devastating consequences. Verifying appropriate placement through aspirate evaluation can be misleading, and post-procedure radiographs increase radiation exposure and ED wait times. Bedside ultrasonography can be used to guide catheter insertion while providing a safe and quick adjunct to confirm proper G-tube placement.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Gastrostomia
/
Ultrassonografia
/
Cirurgia Assistida por Computador
/
Serviços Médicos de Emergência
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
Limite:
Adolescent
/
Adult
/
Child
/
Humans
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article