(662) The Use of POCUS to Confirm Post-Pyloric Tube Placement in Critically Ill Children: A Pilot Study

Introduction: The aim of this study is to investigate the feasibility of Point-of-Care Ultrasound (POCUS) as an alternative imaging modality to confirm appropriate placement of post-pyloric feeding tubes (PPFT) in critically ill children.

Methods: This prospective observational experimental pilot study was performed in a multidisciplinary pediatric intensive care unit (PICU) in a tertiary care university hospital. Twenty-eight pediatric patients 18 years and younger who required post-pyloric feeding tube placement in our PICU between June 2022 and June 2023. The post-pyloric feeding tube was located both by POCUS and abdominal x-ray.

Results: A total of 28 patients were included in this pilot study with 32 insertion attempts. All patients underwent blind bedside placement with a first pass success rate of 93% (30/32) using an adopted abdominal massage technique. POCUS was able to correctly identify PPFT placement in all but two patients whose feeding tube was in the stomach, however, the results were the same as the abdominal x-ray but with less radiation exposure. Not only is POCUS able to confirm PPFT placement when x-ray was unable to, but it was able to identify correct placement 2-3 hours faster than conventional x-ray.

Conclusions: POCUS is a reliable and practical imaging modality to localize and confirm correct placement of PPFT in critically-ill pediatric patients, potentially saving them from radiation exposure by limiting the number of confirmatory x-rays needed. It is more rapid than standard abdominal x-ray by 2-3 hours in some instances and can easily be taught to ICU physicians.