title: Ultrasound can accurately guide gastrostomy tube replacement and confirm proper tube placement at the bedside.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida 32806, USA.
authors.forename: Teresa S
authors.initials: TS
authors.lastname: Wu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leech
authors.forename: Marcy
authors.initials: M
authors.lastname: Rosenberg
authors.forename: Charles
authors.initials: C
authors.lastname: Huggins
authors.forename: Linda
authors.initials: L
authors.lastname: Papa
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004632:Emergency Medical Services; D004868:Equipment Failure; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D012086:Reoperation; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014463:Ultrasonography / Q000295:instrumentation*