Ultrasound provides good diagnostic accuracy in identifying suitable gastric tube placement

Approximately 1 million people a year receive tube feeding in the United States.  Gastric tubes are commonly used to administer drugs and nutrients directly to the gastrointestinal tract (tubes that digest food) to those who can not swallow. Severe pneumonia (infection of the lungs) is caused by catheters placed in the trachea (duct)  dislocated. Therefore, it is important to confirm the gastric tube inserted into the tube. After breathing assistance is provided through the mask, the stomach tube is also used to lower the pressure of the stomach, mainly for resuscitation. Medical ultrasound is one of the diagnostic imaging techniques that uses sound waves to create images of the body's interior. Recent studies have shown that ultrasound provides good 

diagnostic accuracy in identifying suitable tube placement. Therefore, ultrasound can provide a promising alternative to X-ray tube placement, especially 

where X-ray equipment is not available or difficult to access.

 

Stomach tubes are often used to take drugs and tube feeding to people who can not swallow. Eating through a tracheal tube can lead to severe pneumonia. Therefore, it is important to determine the location of the gastric tube after insertion of the tube. 

 

Recent studies have reported that ultrasonography provides a good estimate of diagnostic accuracy in terms of identifying suitable tube placement. Therefore, ultrasound can provide a promising alternative to X-ray tube placement, especially in environments where X-ray equipment is unavailable or inaccessible. We identified 10 studies (545 participants and 560 tubes inserted) that met our inclusion criteria.

 

No study was assigned low risk bias or low concern in each QUADAS-2 area. We only judged three (30%) studies at a lower risk of bias in the area of ??participant selection because they performed an ultrasound examination after confirming the correct location by other means.

 

Due to the low incidence of dislocation, very few data (43 participants) are available for dislocation detection (specificity). We did not conduct meta-analyzes because of significant heterogeneity of exponential tests, such as differences in echo windows, combinations of ultrasound with other validation methods (eg, visualization by sonographic saline flushing), and ultrasound during catheter insertion. The sensitivity of individual studies was estimated from 0.50 to 1.00 for all settings and from 0.17 to 1.00 for specificity. Participants who did not have easy access to X-ray participants underwent gastric tube insertion for drainage (4 studies, 305 participants). Sensitivity was estimated from 0.86 to 0.98 for ultrasound combined with other confirmatory tests, with a specificity estimate Is 1.00, the confidence interval is wide.

 

For studies using ultrasound alone (four studies, 314 participants), the sensitivities ranged from 0.91 to 0.98 and the specificity estimates ranged from 0.67 to 1.00. Fewer studies have a lower risk of bias in the ten studies that assess the diagnostic accuracy of gastric tube placement. Based on limited evidence, ultrasound as a single test to confirm that gastric tube placement is not accurate enough. However, in cases where X-rays are not readily available, ultrasound may help detect misplaced gastric tubes. More research is needed to determine the possibility of using ultrasound to determine adverse events when placing tubes.