78 - Evaluation of generalizability of use of point of care ultrasound by provider type in a level III NICU for confirming naso-gastric/oro-gastric tube position in neonates in an academic setting.

Poster Number: 78
Publication Number: 78.43

Issa Hanna, University of Florida College of Medicine, Jacksonville, FL, United States; Chetan Shah, Wolfson Children's Hospital, Jacksonville, FL, United States; Sfurti Nath, University of Florida College of Medicine- Jacksonville, Jacksonville, FL, United States

Background: Point of care ultrasound (POCUS) is essential to critical care. Decisions based on real-time evaluations & longitudinal monitoring have enhanced quality of care. POCUS skills are not just limited to the intensivists but need to be rapidly acquired by a diverse group of providers to enhace patient care. AAP/COFN recently published recommendations for establishing POCUS training programs in the US to bring this skill set to trainees as well as to practicing physicians.

Objective: To compare accuracy of POCUS imaging/interpretation between two non-radiologist clinicians at different levels of training/experience and evaluate generalizability of our POCUS protocol for confirming OG/NG tube position in neonates admitted to a level III NICU in an academic setting.

Design/Methods: Prospective, observational study. Stable infants ≥30wks were enrolled. Feeding tubes were placed and confirmed per unit protocol. Two clinicians (attending and fellow) trained in POCUS and blinded to x-ray results, obtained 2 images/patient (transverse supraglottic and epigastric longitudinal tilted view) to identify OG/NG ( < 48 hrs from last xray) using GE venue 50 [linear (8-11Mhz);curved array (4-8 MHz) probe] Image1. Pediatric radiologist blinded to study subjects and x-ray then evaluated and compared the images.   

Results: n=50, median GA 34(±3.8) wks; mean BW 2063(±940) grams. Avg. time to obtain/ interpret images was 1.18 (± 0.47) mins. Table 1 shows POCUS comparison of two clinicians. Both made correct selections for probes, presets, appropriate adjustments for image gain and depth with proper orientation of the marker. Both identified landmarks correctly in all infants. Each had 6/50 (12%) poor quality images in transverse supraglottic view but OG/NG was correctly identified in all images. In epigastric view, both could correctly identify OG/NG in stomach in 48/50 infants (96%). 2 images were poor quality due to stomach air interposition. One was in the esophagus (true negative) and one was not visualized (false negative). Direct identification by US gave a sensitivity of 97.9% & specificity of 100%, a PPV of 100% and a NPV of 50%. No clinically significant difference was found in the quality or interpretation of images between the two clinicians.

Conclusion(s): Structured POCUS training enhances clinical skills at all experience levels. We found no difference in accuracy/interpretation of POCUS images for confirming OG/NG tube position between attending and fellow highlighting the generalizability of our POCUS protocol and training. Larger studies are needed to support our results & refine POCUS protocols further