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Minerva Anestesiol. 2019 May 21. doi: 10.23736/S0375-9393.19.13530-4. [Epub ahead of print]

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

Author information

1
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA - tollincl@mskcc.org.
2
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
3
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
4
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
5
Department of Anesthesiology, Marian University, Indianapolis, IN, USA.

Abstract

BACKGROUND:

Over a million gastric tubes are placed yearly for varying medical reasons including gastric decompression. In the 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, BMI, 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 demonstrate 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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