Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department
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Point‑of‑care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department Stephen Alerhand1 · Ee Tein Tay2 Received: 18 October 2019 / Accepted: 13 February 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Gastrostomy tubes (G-tubes) are frequently used in children for feeding and nutrition. Complications related to G-tubes (and G-buttons) in children represent a common presentation to the emergency department (ED). G-tube replacement is usually performed by pediatric emergency medicine physicians. Misplacement may lead to tract disruption, perforation, fistula tract formation, or feeding into the peritoneum. Contrast-enhanced radiographs are traditionally used for confirmation. In addition to a longer length-of-stay, repeat ED visits result in repeated radiation exposure. The use of point-of-care ultrasound (POCUS) instead of radiography avoids this exposure to ionizing radiation. Here, we describe three patients who presented with G-tube complications in whom POCUS alone performed by pediatricians was used for confirmation of the tubes’ replacement. Two children presented to the ED with G-tube dislodgement, and one child presented with a ruptured balloon. In all three cases, a new G-tube was replaced at the bedside using POCUS guidance without the need for further radiographic studies. There were no known ED or clinic returns for G-tube complaints over the next 30 days. This is the first report of pediatricians using POCUS to guide and confirm G-tube replacement in children. The success of these cases suggests the technique’s feasibility. Future prospective studies are needed to evaluate the learning curves, diagnostic accuracy, ED length-of-stay, and use of confirmatory imaging. Keywords Ultrasound · Point-of-care ultrasound · POCUS · Gastrostomy tube
Introduction Gastrostomy tubes (G-tubes) are frequently used in children for feeding and nutrition. In 2001, approximately 11,000 G-tubes were placed in the pediatric population [1]. Complications related to G-tubes in children represent a common presentation to the emergency department (ED). After the initial G-tube placement, 8.6% of pediatric patients in a retrospective cohort study by Goldin et al. visited the ED within 30 days of discharge [2]. In a retrospective cross-sectional Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02294-3) contains supplementary material, which is available to authorized users. * Stephen Alerhand [email protected] 1
Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY 10016, USA
2
study by Saavedra et al., children
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