Appropriateness Criteria of Point-of-Care Ultrasound for Nasogastric Tube Placement Confirmation

Purpose: The purpose of this study is to initiate implementation of Point-of-Care Ultrasound (POCUS) as “usually appropriate” initial imaging modality for nasogastric tube (NGT) placement for intensive care unit (ICU) patients according to American College of Radiology (ACR) Appropriateness Criteria. Currently, nasogastric tube placement is confirmed with chest x-ray as the gold standard. Complications of improper placement can be fatal, such as pneumothorax and aspiration pneumonia. Effective NGT placement confirmation is accurate, timely and non-invasive to the patient. Current ACR Appropriateness Criteria for ICU patients with nasogastric tube placement indicate Portable Chest Radiograph “usually appropriate” and Chest Ultrasound “may be appropriate” as initial imaging.

Methods/Materials: Literature review of 21 studies was performed utilizing PubMed, which included randomized controlled trials, meta-analyses and literature reviews. Inclusion criteria were terms “bedside ultrasound, “point-of-care ultrasound” and “nasogastric tube placement”. Exclusion criteria were literature published greater than 10 years ago.

Results: Through the literature review, several critical care studies have shown high sensitivities (97-100%) and specificity of 100% with POCUS for NGT placement confirmation. Several critical care studies have shown POCUS-confirmed NGT placement performed and interpreted in less than 10 minutes with an average of 5 minutes.

Conclusions: POCUS is equally non-invasive, facilitates dynamic evaluation, reduces patient radiation exposure and provides confirmation faster than portable x-ray. Beneficially, POCUS can be used rapidly at bedside, provides better access and interpretive ability in clinical real time. As point-of-care ultrasound has shown similar capability as chest x-ray, implementation of POCUS as “usually appropriate” initial imaging for ICU patients with nasogastric tube placement can improve patient safety and optimize patient care.