key: cord-0681760-5h6bhoc0
authors: Yadav, Sangam; Singh, Abhishek; Bhattacharjee, Anirban; Khanna, Puneet; Manisha, Kalung
title: Role of point of care ultrasound to determine the correct position of the nasogastric tube in intubated COVID -19 patients
date: 2020-08-28
journal: nan
DOI: 10.1016/j.tacc.2020.08.008
sha: 533494ca48c8eda96b46738cc0e2f7a9cae8ca4c
doc_id: 681760
cord_uid: 5h6bhoc0

nan

Role of point of care ultrasound to determine the correct position of the nasogastric tube in intubated COVID -19 patients Respected sir, Enteral route of nutrition via a nasogastric tube (NG) is the preferred mode for feeding in critically ill patients. In COVID-19 ICU, where chances of cross-infection are common, the stethoscope has lost most of its significance. Confirmation of NG tube is of paramount importance since a wrongly placed NG tube can lead to trachea-bronchial injury, pulmonary hemorrhage, pneumothorax, pneumo-mediastinum, subcutaneous emphysema, and pneumonia. [1] In an awake patient, the diagnosis is relatively simple as the patients will start coughing once the NG tube is in the trachea-bronchial tree, but it is difficult to decipher in sedated/paralyzed intubated patients. There are several techniques for conformation of NG placement like testing of pH of the aspirate, auscultation over epigastrium by pushing air, chest X-ray, and ultrasound (USG). In the COVID-19 pandemic, the recommendation against the use of stethoscope and difficulty in transporting the patients makes USG a lucrative option.

The technique requires the involvement of two physicians, one inserting the NG tube and the other person performing the USG scan. The learning curve for the same is short in people trained with USG guided catheter placement and visualization of the trachea during percutaneous dilation tracheostomy. [2] Linear high-frequency probe is required to visualize the NG tube in the neck whereas a high-frequency curvilinear probe is required for abdominal structures. The cervical part ( Chest X-ray (CXR) can be a feasible option in weighted tip NG but most ICU uses the nonweighted NG now, hence the role of CXR is limited. The time for obtaining a CXR is comparatively more than USG. USG reduces time and cut down expenses as well. [4] USG also reduces the radiation exposure, hence it is useful in patients in whom exposure is undesirable e.g. pregnancy. USG helps in guiding the passage NG in a surgical patient in whom placement is difficult. One important thing to be kept in mind is to paralyze the patient while doing NG insertion in ICU as it avoids aerosolization around the endotracheal tube.

USG maintenance in the COVID area is also equally important for the safety of the health care worker. There should be a designated ultrasound for COVID-19 area in the hospital, J o u r n a l P r e -p r o o f handheld devices are preferred as they can be easily cleaned, touch screen machines are preferable than keyboard-based machines while performing aerosol-generating procedures in the operation room or ICU, all the non-essential components of the ultrasound machine should be covered by clear plastic and sheaths should be used to cover cord and probe which should be removed after scanning, wipe the entire machine surface with ethanol wipes inside the procedure room before doffing.

USG is an extra pair of eyes of an anesthetist. Proper application of USG will not only improve patient safety and outcome but will also reduce the incidence of infection among patients and healthcare workers.

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