Use of bedside ultrasound to confirm the positioning of the enteral catheter in critically ill patients

Abstract

Abstract Introduction: Enteral catheter (EC) nutrition is the most commonly used alternative in critically ill patients who require nutritional therapy. The incorrect positioning of the EC can result in severe complications. The plain X-ray, the gold standard method to confirm EC positioning has some disadvantages, such as radiation emission, loss of invasive devices, and adverse events. Few studies have investigated the role of bedside ultrasound (BUS) in the context. Aim: To evaluate the agreement between the BUS in a single epigastric window and the plain X-ray to confirm the positioning of the EC in critically ill patients. Methods: This was an observational, cross-sectional study conducted in two Intensive Care Units (ICUs) of a university hospital, from July 2020 to March 2021. Included in this study were adult patients (age > or = 18 years) with a recommendation for enteral nutrition. The ultrasound exams were carried out immediately after the introduction of the EC, using only the epigastric window, with an injection of 5 ml of air associated with 5 ml of saline solution. In all cases, the plain radiography was taken to confirm the positioning of the EC and to define the beginning of nutritional therapy. Results: This study included 83 patients, with a median age of 60 (50-70) years, 51.8% of whom were female. The median body mass index (BMI) was 26.4 (23.8-30.1) kg/m2 and the median SOFA score was 8 (5-10) points. The mortality rate in the ICU was 50.6%. The positioning of the EC was confirmed by plain radiography in all cases and by ultrasound in 81 (97.6%) patients. The non-identification of the EC by ultrasound in two patients occurred due to abdominal distension caused by gas interference. The median duration of the ultrasound exam was 2 (2-3) minutes, while the time spent between the request for the X-ray and the release of the exam for a doctor’s appointment was 225 (120-330) minutes. Neither BUS nor X-ray was associated with the occurrence of adverse events. Conclusion: BUS proved to be an effective, quick, and safe method to confirm the position of the EC in critically ill patients. Clinical trials comparing outcomes related to the use of EC when confirmed by ultrasound or X-ray are warranted.