title: 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients.
abstract: OBJECTIVE
  Nasogastric feeding tube is routinely positioned in intensive care units. The complications of misplacement are rare but very dangerous for the patients. The aim of this study is to estimate the diagnostic accuracy of this new technique, 4-point ultrasonography to confirm nasogastric tube placement in intensive care.
  
  
  METHODS
  One hundred fourteen critical ill patients monitored in ICU were included. The intensivist provided in real time to perform the exam in four steps: sonography from either the right or left side of the patient's neck to visualize the esophagus, sonography of epigastrium to confirm the passage through the esophagogastric junction and the positioning in antrum, sonography of the fundus. Finally, gastric placement of the nasogastric feeding tube was confirmed with thorax radiograph.
  
  
  RESULTS
  One hundred fourteen of the gastric tubes were visualized by sonography in the digestive tract and all were confirmed by radiography (sensitivity 100%). The entire sonographic procedure, including the longitudinal and transversal scan of the esophagus, the esophagogastric junction, the antrum and the fundus, took 10 min.
  
  
  CONCLUSIONS
  Our pilot study demonstrated that not weighted-tip gastric tube routinely used in Intensive Care is visible with the sonography. The pilot study confirmed the high sensitivity of the sonography in the verify correct positioning of gastric tube in the adult ICU patients. The ultrasound examination seems to be easy and rapid even when performed by a intensivist whit a sonographic training of only 40 h. The sonographic exam at the bedside was performed in a shorter time than the acquisition and reporting of the X-ray.
authors.affiliation: Department of Intensive Care, Regional Hospital of Bolzano, Bolzano, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Zatelli
authors.affiliation: Department of Radiology, Regional Hospital of Bolzano, Bolzano, Italy.
authors.forename: Norberto
authors.initials: N
authors.lastname: Vezzali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D010865:Pilot Projects; D000067716:Point-of-Care Testing; D013902:Radiography, Thoracic; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: Enteral nutrition; Nasogastric tube; Sonography