12 - Point of Care Ultrasound Feeding Our Children (POCUS FOCUS): Sensitivity and Specificity of Ultrasound to Confirm Placement of Enteral Feeding Tubes

Poster Number: 12
Publication Number: 12.107

Andrew Walls, Phoenix Children's Hospital, Avondale, AZ, United States; Erik Su, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, United States; Frederick A. Willyerd, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: The point of care ultrasound (POCUS) is the next frontier in pediatric critical care medicine due to its ease of use and potential to reduce radiation exposure. Currently, there are limited publications investigating the use of POCUS to evaluate enteral feeding tube placement in the pediatric population.

Objective: To determine the sensitivity and specificity of POCUS to evaluate the positioning of enteral feeding tubes in the pediatric population compared to radiographic imaging as the gold standard.

Design/Methods: A total of 40 patients were included in this prospective, single blinded, cohort study to determine the sensitivity and specificity of POCUS regarding enteral feeding tube placement in the pediatric critical care population. Patient demographics including: gender, age, ethnicity, body mass index, vasoactive/paralytic use and intubation status were all collected. After a nasogastric feeding tube was placed by bedside nursing staff, a bedside ultrasound was performed to determine location of the feeding tube. The physician was blinded to the pH paper findings and abdominal imaging result until the bedside ultrasound was completed. Sensitivity and specificity were then calculated utilizing both pH paper analysis and abdominal imaging results as the gold standard.

Results: Upon review, the majority of patients were Caucasian and Hispanic and had an average age of 77.4 (+/- 36.2) months and there was an even distribution between males and females (21 vs. 19), respectively. The average patient BMI was 18.8 (+/- 7.6 kg/m²). Furthermore, 15 (38%) patients were intubated and 10 (25%) required vasoactive medications. When all patients were included in the calculation, the sensitivity and specificity of POCUS was found to be 89% and 67%, respectively, when compared to abdominal imaging and pH paper analysis. Interestingly, when we removed patients with overweight and obese BMIs, the sensitivity and specificity improved to 94% and 100%, respectively compared to abdominal imaging and 97% and 67% when compared to pH paper analysis. 

Conclusion(s): Our group determined that POCUS provides high sensitivity and specificity when compared to abdominal X-Ray to determine the placement of enteral feeding tubes in patients with healthy BMI. This study was performed by critical care staff without formal radiology residency training and supports the generalizability of our findings to use amongst other institutions.