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. 2019 Nov;85(11):1168-1174.
doi: 10.23736/S0375-9393.19.13530-4. Epub 2019 May 21.

The incidence of intraoperative gastric tube malposition verified by Point-of-Care Ultrasound

Luis E Tollinche  1 , Duan Li  2 , Lucia Salamanca-Cardona  3 , Kay S Tan  4 , David O'connor  3 , Howard Teng  3 , Gloria Yang  3 , Michael Long  5 , Cindy B Yeoh  3
Affiliations

The incidence of intraoperative gastric tube malposition verified by Point-of-Care Ultrasound

Luis E Tollinche et al. Minerva Anestesiol. 2019 Nov.

Abstract

Background: Over a million gastric tubes are placed yearly for varying medical reasons including gastric decompression. In the operating room (OR), this is performed blindly, and position is confirmed by auscultation, aspiration, or palpation by a surgeon. Despite the known risks of malpositioned gastric tubes, there is limited data in anesthesia literature about the incidence of intraoperative malpositioned gastric tubes. In this study, we use Point-of-Care ultrasonography (POCUS) to confirm gastric tube placement in the OR.

Methods: Prospective observational study with a total of 149 subjects, all over 18 years of age, undergoing surgery with general endotracheal anesthesia and intraoperative blind placement of a gastric tube by an anesthesia provider. The primary objective of this study is to determine the incidence of malposition of blindly placed gastric tubes.

Results: In our analysis, we found that out of 149 patients 110 patients were successfully visualized; the incidence of malposition was 0.14 [95% CI: 0.08-0.21]. We did not find age, Body Mass Index, or sex to be associated with predisposing patients to intraoperative malposition of gastric tube. However, increasing years of experience of anesthesia provider correlated with higher malposition rates.

Conclusions: In summary, we demonstrated that the incidence of malposition of blindly gastric tubes was 14%. Given the attendant risks of malpositioned gastric tubes, this data should inform decision algorithms for the blind placement of gastric tubes.

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Conflict of interest statement

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1.—
Figure 1.—
Longitudinal view representation of the substernal region. A) Transverse view of GE junction (arrow) without gastric tube; B) transverse view of gastric tube in place at the GR junction (descending arrow, red in the online version).
Figure 2.—
Figure 2.—
Incidence of malposition based on years of experience of anesthesia provider.
See this image and copyright information in PMC

Comment in

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