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Tsujimoto Y, Kataoka Y, Banno M, Anan K, Shiroshita A, Jujo S. Ultrasonography for confirmation of gastric tube placement. Cochrane Database Syst Rev 2024; 7:CD012083. [PMID: 39051488 PMCID: PMC11270641 DOI: 10.1002/14651858.cd012083.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Gastric tubes are commonly used for the administration of drugs and tube feeding for people who are unable to swallow. Feeding via a tube misplaced in the trachea can result in severe pneumonia. Therefore, the confirmation of tube placement in the stomach after tube insertion is important. Recent studies have reported that ultrasonography provides good diagnostic accuracy estimates in the confirmation of appropriate tube placement. Hence, ultrasound could provide a promising alternative to X-rays in the confirmation of tube placement, especially in settings where X-ray facilities are unavailable or difficult to access. OBJECTIVES To assess the diagnostic accuracy of ultrasound alone or in combination with other methods for gastric tube placement confirmation in children and adults. SEARCH METHODS This systematic review is an update of a previously published Cochrane review. For this update, we searched the Cochrane Library (2021, Issue 6), MEDLINE (to April 2023), Embase (to April 2023), five other databases (to July 2021), and reference lists of articles, and contacted study authors. SELECTION CRITERIA We included studies that evaluated the diagnostic accuracy of naso- and orogastric tube placement confirmed by ultrasound visualization using X-ray visualization as the reference standard. We included cross-sectional studies and case-control studies. We excluded case series or case reports. We excluded studies if X-ray visualization was not the reference standard or if the tube being placed was a gastrostomy or enteric tube. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality and extracted data from each of the included studies. We contacted the authors of the included studies to obtain missing data. There were sparse data for specificity. Therefore, we performed a meta-analysis of only sensitivity using a univariate random-effects logistic regression model to combine data from studies that used the same method and echo window. MAIN RESULTS We identified 12 new studies in addition to 10 studies included in the earlier version of this review, totalling 1939 participants and 1944 tube insertions. Overall, we judged the risk of bias in the included studies as low or unclear. No study was at low risk of bias or low concern for applicability in every QUADAS-2 domain. There were limited data (152 participants) for misplacement detection (specificity) due to the low incidence of misplacement. The summary sensitivity of ultrasound on neck and abdomen echo windows were 0.96 (95% confidence interval (CI) 0.92 to 0.98; moderate-certainty evidence) for air injection and 0.98 (95% CI 0.83 to 1.00; moderate-certainty evidence) for saline injection. The summary sensitivity of ultrasound on abdomen echo window was 0.96 (95% CI 0.65 to 1.00; very low-certainty evidence) for air injection and 0.97 (95% CI 0.95 to 0.99; moderate-certainty evidence) for procedures without injection. The certainty of evidence for specificity across all methods was very low due to the very small sample size. For settings where X-ray was not readily available and participants underwent gastric tube insertion for drainage (8 studies, 552 participants), sensitivity estimates of ultrasound in combination with other confirmatory tests ranged from 0.86 to 0.98 and specificity estimates of 1.00 with wide CIs. For studies of ultrasound alone (9 studies, 782 participants), sensitivity estimates ranged from 0.77 to 0.98 and specificity estimates were 1.00 with wide CIs or not estimable due to no occurrence of misplacement. AUTHORS' CONCLUSIONS Of 22 studies that assessed the diagnostic accuracy of gastric tube placement, few studies had a low risk of bias. Based on limited evidence, ultrasound does not have sufficient accuracy as a single test to confirm gastric tube placement. However, in settings where X-ray is not readily available, ultrasound may be useful to detect misplaced gastric tubes. Larger studies are needed to determine the possibility of adverse events when ultrasound is used to confirm tube placement.
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Affiliation(s)
- Yasushi Tsujimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Oku Medical Clinic, Osaka, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Masahiro Banno
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan
| | - Keisuke Anan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Akihiro Shiroshita
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Satoshi Jujo
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
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Henderson RDE, Padash S, Adams SJ, Augusta C, Yi X, Babyn P. Neonatal Catheter and Tube Placement and Radiographic Assessment Statistics in Relation to Important Anatomic Landmarks. Am J Perinatol 2024; 41:e2299-e2306. [PMID: 37494483 DOI: 10.1055/s-0043-1771051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Neonatal catheters and tubes are commonly used for monitoring and support for intensive care and must be correctly positioned to avoid complications. Position assessment is routinely done by radiography. The objective of this study is to characterize neonatal catheter and tube placement in terms of the proportion of those devices that are malpositioned. STUDY DESIGN Using an institutional dataset of 723 chest/abdominal radiographs of neonatal intensive care unit (ICU) patients (all within 60 days of birth), we assessed the proportion of catheters that are malpositioned. Many radiographs contained multiple catheter types. Umbilical venous catheters (UVCs; 448 radiographs), umbilical arterial catheters (UACs; 259 radiographs), endotracheal tubes (ETTs; 451 radiographs), and nasogastric tubes (NGTs; 603 radiographs) were included in our analysis. RESULTS UVCs were malpositioned in 90% of radiographs, while UACs were malpositioned in 36%, ETTs in 30%, and NGTs in just 5%. The most common locations in which UVCs were malpositioned were in the right atrium (31%) and umbilical vein (21%), and for UACs the most common malpositioned tip location was the aortic arch (8%). For the remaining tubes, 5% of ETTs were found to be in the right main bronchus and 4% of NGTs were found in the esophagus. CONCLUSION A substantial proportion of catheters and tubes are malpositioned, suggesting that optimizing methods of catheter placement and assessment ought to be areas of focus for future work. KEY POINTS · Neonatal catheters are frequently malpositioned.. · Most umbilical venous catheters need readjustment.. · X-ray and ultrasound are important for assessment.. · Catheter tips should be assessed in all X-rays..
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Affiliation(s)
- Robert D E Henderson
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sirwa Padash
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Scott J Adams
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Carolyn Augusta
- Department of Finance and Management Science, Edwards School of Business, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Xin Yi
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Babyn
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Pawlowski TW, Polidoro R, Fraga MV, Biasucci DG. Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives. Eur J Pediatr 2024; 183:1037-1045. [PMID: 38085280 DOI: 10.1007/s00431-023-05372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 03/20/2024]
Abstract
Point-of-care ultrasound (POCUS) has been established as an essential bedside tool for real-time image guidance of invasive procedures in critically ill neonates and children. While procedural guidance using POCUS has become the standard of care across many adult medicine subspecialties, its use has more recently gained popularity in neonatal and pediatric medicine due in part to improvement in technology and integration of POCUS into physician training programs. With increasing use, emerging data have supported its adoption and shown improvement in pediatric outcomes. Procedures that have traditionally relied on physical landmarks, such as thoracentesis and lumbar puncture, can now be performed under direct visualization using POCUS, increasing success, and reducing complications in our most vulnerable patients. In this review, we describe a global and comprehensive use of POCUS to assist all steps of different non-vascular invasive procedures and the evidence base to support such approach. CONCLUSION There has been a recent growth of supportive evidence for using point-of-care ultrasound to guide neonatal and pediatric percutaneous procedural interventions. A global and comprehensive approach for the use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures. WHAT IS KNOWN • Point-of-care ultrasound has been established as a powerful tool providing for real-time image guidance of invasive procedures in critically ill neonates and children and allowing to increase both safety and success. WHAT IS NEW • A global and comprehensive use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures: from diagnosis to semi-quantitative assessment, and from real-time puncture to follow-up.
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Affiliation(s)
| | | | - María V Fraga
- Children's Hospital of Philadelphia, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy.
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Perry A, Kaiser J, Kruger K, Horigan AE, Bradford JY, Camarda A, DeGroot D, Dixon C, MacPherson-Dias R, Slifko A, Slivinski A, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Gastric Tube Placement Verification. J Emerg Nurs 2024; 50:301-304. [PMID: 38453344 DOI: 10.1016/j.jen.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 03/09/2024]
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Pan S, Lin C, Tsui BCH. Neonatal and paediatric point-of-care ultrasound review. Australas J Ultrasound Med 2023; 26:46-58. [PMID: 36960139 PMCID: PMC10030095 DOI: 10.1002/ajum.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Purpose Point-of-care ultrasound (POCUS) examinations for children and newborns are different from POCUS exams for adults due to dissimilarities in size and body composition, as well as distinct surgical procedures and pathologies in the paediatric patient. This review describes the major paediatric POCUS exams and how to perform them and summarizes the current evidence-based perioperative applications of POCUS in paediatric and neonatal patients. Method Literature searches using PubMed and Google Scholar databases for the period from January 2000 to November 2021 that included MeSH headings of [ultrasonography] and [point of care systems] and keywords including "ultrasound" for studies involving children aged 0 to 18 years. Results Paediatric and neonatal POCUS exams can evaluate airway, gastric, pulmonary, cardiac, abdominal, vascular, and cerebral systems. Discussion POCUS is rapidly expanding in its utility and presence in the perioperative care of paediatric and neonatal patients as their anatomy and pathophysiology are uniquely suited for ultrasound imaging applications that extend beyond the standard adult POCUS exams. Conclusions Paediatric POCUS is a powerful adjunct that complements and augments clinical diagnostic evaluation and treatment.
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Affiliation(s)
- Stephanie Pan
- Department of Anesthesiology, Perioperative, and Pain MedicineStanford University School of Medicine300 Pasteur DrivePalo AltoCalifornia94305USA
| | - Carole Lin
- Department of Anesthesiology, Perioperative, and Pain MedicineStanford University School of Medicine300 Pasteur DrivePalo AltoCalifornia94305USA
| | - Ban C. H. Tsui
- Department of Anesthesiology, Perioperative, and Pain MedicineStanford University School of Medicine300 Pasteur DrivePalo AltoCalifornia94305USA
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Ultrasound to Verify Gastric Tube Position in Infants and Children: A Systematic Review. Adv Neonatal Care 2022; 22:531-538. [PMID: 35587385 DOI: 10.1097/anc.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Placement of gastric tubes is commonly performed in infants and children but malpositioning is common and is associated with significant complications. OBJECTIVE The aim of this systematic review is to identify the evidence on the use of ultrasound to verify correct gastric tube placement in infants and children and gaps in the research. METHODS This review was performed using CINAHL, PUBMED, EMBASE and Web of Science databases. Studies were included if they used an empirical study design, were published in English, included infants or children, and evaluated the use of ultrasound to verify correct gastric tube placement compared to radiograph. Sensitivity, specificity, positive and negative predictive values were evaluated. RESULTS Four articles were included in the review. Sensitivity estimates were 0.88 to 1.00 and a positive predictive value of 0.99 was reported in one study. Specificity was not reported in any of the included studies. Ultrasound may be an important method to correctly identify gastric tube placement in infants and children with less radiation exposure and cost. IMPLICATIONS FOR PRACTICE Ultrasound could be a used to verify gastric tube positioning in infants and children for both initial placement and continued verification leading to reduced radiation exposure and cost. IMPLICATIONS FOR RESEARCH Research should focus on evaluating ultrasound specificity and the clinical feasibility of using ultrasound as a standard practice, including cost and time required to complete the exam, as well as the ability of ultrasound to verify gastric tube placement in infants weighing less than 1500 grams.
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Valla FV, Tume LN, Jotterand Chaparro C, Arnold P, Alrayashi W, Morice C, Nabialek T, Rouchaud A, Cercueil E, Bouvet L. Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review. Front Pediatr 2022; 10:921863. [PMID: 35874585 PMCID: PMC9298849 DOI: 10.3389/fped.2022.921863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children. Materials and Methods An international expert group was established, composed of pediatricians, pediatric intensivists, anesthesiologists, radiologists, nurses, and a methodologist. A scoping review was conducted with an aim to describe the use of gastric POCUS in pediatrics in acute and critical care settings. A literature search was conducted in three databases, to identify studies published between 1998 and 2022. Abstracts and relevant full texts were screened for eligibility, and data were extracted, according to the JBI methodology (Johanna Briggs Institute). Results A total of 70 studies were included. Most studies (n = 47; 67%) were conducted to assess gastric emptying and gastric volume/contents. The studies assessed gastric volume, the impact of different feed types (breast milk, fortifiers, and thickeners) and feed administration modes on gastric emptying, and gastric volume/content prior to sedation or anesthesia or during surgery. Other studies described the use of gastric POCUS in foreign body ingestion (n = 6), nasogastric tube placement (n = 5), hypertrophic pyloric stenosis (n = 8), and gastric insufflation during mechanical ventilatory support (n = 4). POCUS was performed by neonatologists, anesthesiologists, emergency department physicians, and surgeons. Their learning curve was rapid, and the accuracy was high when compared to that of the ultrasound performed by radiologists (RADUS) or other gold standards (e.g., endoscopy, radiography, and MRI). No study conducted in critically ill children was found apart from that in neonatal intensive care in preterms. Discussion Gastric POCUS appears useful and reliable in a variety of pediatric clinical settings. It may help optimize induction in emergency sedation/anesthesia, diagnose foreign bodies and hypertrophic pyloric stenosis, and assist in confirming nasogastric tube placement, avoiding delays in obtaining confirmatory examinations (RADUS, x-rays, etc.) and reducing radiation exposure. It may be useful in pediatric intensive care but requires further investigation.
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Affiliation(s)
- Frederic V. Valla
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lyvonne N. Tume
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Philip Arnold
- Department of Anaesthetics, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Walid Alrayashi
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Claire Morice
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Tomasz Nabialek
- Pediatric Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Aymeric Rouchaud
- Pediatric Radiology Department, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Eloise Cercueil
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- Department of Anesthesiology and Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
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The Need for Valid and Reliable Methods to Determine Feeding Tube Insertion Length and Verify Placement in Neonates to Improve Safe Nursing Care. J Perinat Neonatal Nurs 2021; 35:204-206. [PMID: 34330130 DOI: 10.1097/jpn.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Tsujimoto H. For Better Patient Safety: The Role of Ultrasonography in Gastric Tube Placement. Chest 2021; 159:2147-2148. [PMID: 34099124 DOI: 10.1016/j.chest.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki, General Medical Center.
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Point-of-care ultrasound in pediatric anesthesia: perioperative considerations. Curr Opin Anaesthesiol 2020; 33:343-353. [PMID: 32324662 DOI: 10.1097/aco.0000000000000852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the perioperative applications of point-of-care ultrasound (POCUS). RECENT FINDINGS The role of point-of-care ultrasonography for perioperative care is expanding with respect to perioperative application. The imaging approach can complement the physical exam and provide additional information for decision-making in pediatric perioperative medicine. This review will focus on applications in the following organ systems: airway, cardiac, pulmonary and gastric. Specifically, POCUS of the airway has been used to optimize endotracheal tube depth, aid in tube size selection and predict difficulty with laryngoscopy and intubation. Lung POCUS has been used to assess for causes hypoxemia as well as to optimize ventilatory mechanics. Cardiac POCUS has been used for assessment of hemodynamics, valvular and ventricular function. Gastric ultrasound has emerged as an evaluative mechanism of gastric content in the setting of fasting as well as to confirm placement of gastric tubes. The applications of POCUS in the perioperative setting continue to evolve as a reliable diagnostic tool that can assist in timely diagnosis, improve procedural safety and has the potential to improve patient outcomes. SUMMARY The utility of perioperative POCUS has been well demonstrated, specifically for examination of the airway, stomach and cardiopulmonary system. It is advisable for the novice sonographer to perform POCUS within the guidelines set by the American Society of Echocardiography regarding basic POCUS. As with all diagnostic modalities, understanding the limitations of ultrasound and POCUS as well as continuous self-assessment is crucial.
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Wenhong GMD, Shunji GMD, Qun-An HMD, Huijuan XMD. Bedside Ultrasonography-Guided Nasogastric Tube Placement in COVID-19 Patients. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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