[Abstract] 524: A LIGHT-GUIDED TECHNIQUE OF GASTRIC INTUBATION

Learning Objectives: Endogastric tube (EGT) placement is a common pediatric intensive care unit patient procedure. Indications include feeding, gastric decompression, and medication administration. Drawbacks associated with EGT placement consist of pneumothorax, pneumonia, asphyxia, intracranial intubation and/or death. Between 2 – 4% (nearly 500,000) nasogastric. percutaneous endoscopic gastrostomy tubes and suction tubes are misplaced every year (Gilbert P J, Healthcare Risk Management; April 2015: 44–45). Confirmation of proper EGT placement in the stomach or gastrointestinal tract is essential to prevent these complications. The most reliable method of confirmation is a chest or abdominal x-ray which is standard hospital policy at many institutions. This X-ray is costly and exposes the patient to harmful radiation. Dislodgement of EGTs requires replacement with reconfirmation via X-ray; subjecting the child to additional radiation exposure. A self-illuminating stylet inserted into the EGT to identify proper placement with the naked eye could minimize improper placement, complications, radiation exposure, and cost. Methods: In previously anesthetized, expired neonatal lambs, a self-illuminating prototype stylet connected to a fiberoptic light source was used to insert a standard EGT into the gastric cavity via the mouth. Upon EGT placement, the light at the end of the stylet was followed as it passed through the lamb’s body. With identification of the translucent light below the ribcage, placement was believed to be in the correct position. The actual position of the tube was confirmed using direct dissection through the abdominal wall into the stomach cavity noting the tip of the EGT. Results: In seven neonatal lambs weighing 3.4–7.2kg (mean 4.5) a standard orogastric tube was placed using the self-illuminating stylet. In all animals the translucent light was identified in the neck, disappeared in the thoracic cavity region, and reappeared just below the ribcage. The tube position was confirmed with direct dissection identifying the tip of the EGT in the stomach cavity in 100% of the lambs. Conclusions: EGTs may be successfully placed using a self-illuminating stylet and confirmed via location of the translucent light below the ribcage. No X-ray is necessary to check position. This can decrease cost, radiation exposure, and improper placement. Children in the intensive care unit can benefit from this technique.