Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department.

Internal and Emergency Medicine
Stephen Alerhand, Ee Tein Tay

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 g...Continue Reading

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Citations

Jul 4, 2021·Emergency Medicine Clinics of North America·Alamelu Natesan, Solomon Behar
Jun 23, 2021·Journal of Pediatric Gastroenterology and Nutrition·Matjaž HomanJorge Amil-Dias

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