Sasaki Takato, Nemoto Yuri, Nishigata Aya, Aoyama Tomohiro, Masumoto Kouji
Department of Pediatric Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.
Cureus. 2025 Jan 3;17(1):e76871. doi: 10.7759/cureus.76871. eCollection 2025 Jan.
To confirm that the tip of a gastric tube is properly positioned within the stomach, commonly used methods include simple X-ray examination, the auscultation of gastric bubble sounds, and pH testing of aspirated fluids. However, these methods have limitations, such as concerns regarding radiation exposure and accuracy. We utilized the Tumguide(Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan), a gastric tube tip verification system that employs biologically transparent (BT) red light-emitting diode (LED) light, for gastric tube insertion in five pediatric patients with conditions considered unfavorable for BT light transmission. Based on our experience, we report key considerations regarding its indications and applications. In all cases, the system was used under general anesthesia during preoperative gastric tube insertion for the patients' underlying conditions. Gastric tube insertion was successfully performed without complications in all cases. However, in one case involving the use of an 8 Fr Salem Sump™ tube (Cardinal Health K.K., Tokyo, Japan) for decompression, a difficulty arose in removing the fiber. This issue was resolved by removing the fiber along with the tube, filling the tube with water, and reinserting it. In a girl with jaundice due to biliary atresia (serum total bilirubin level of 8.7 mg/dL) and a boy with dark skin, the visibility of the BT light was reduced due to skin pigmentation. However, dimming the room lights enhanced visibility. In one case where a colostomy overlapped the stomach and in two cases where preoperative CT scans confirmed that the left lobe of the liver overlapped the stomach, the BT light was clearly visible, enabling accurate guidance and the confirmation of the tube tip position. Postoperative X-ray examinations were conducted in four out of the five cases, confirming the correct placement of the tube tip in the stomach. Based on our experience and previous reports, the BT light-based gastric tube tip verification system, which uses red LED light to confirm the position of the nasogastric tube tip, has proven to be an effective tool for the real-time verification of nasogastric tube placement in young children.
为确认胃管尖端是否正确置于胃内，常用方法包括简单的X线检查、听诊胃泡音以及对吸出液进行pH检测。然而，这些方法存在局限性，如涉及辐射暴露和准确性方面的问题。我们对5例被认为不利于生物透明（BT）光传输的儿科患者使用了Tumguide（日本德岛大冢制药株式会社），这是一种采用BT红光发光二极管（LED）光的胃管尖端验证系统来插入胃管。基于我们的经验，我们报告了关于其适应证和应用的关键注意事项。在所有病例中，该系统均在全身麻醉下于术前因患者基础疾病插入胃管时使用。所有病例均成功插入胃管且无并发症。然而，在1例使用8 Fr Salem Sump™管（日本东京卡地纳健康株式会社）进行减压的病例中，出现了取出光纤困难的情况。通过将光纤与管子一起取出、用水填充管子并重新插入解决了该问题。在1例因胆道闭锁导致黄疸（血清总胆红素水平为8.7 mg/dL）的女孩和1例皮肤黝黑的男孩中，由于皮肤色素沉着，BT光的可见度降低。然而，调暗室内灯光可提高可见度。在1例结肠造口与胃重叠的病例以及术前CT扫描证实肝左叶与胃重叠的2例病例中，BT光清晰可见，从而能够进行准确引导并确认管尖位置。5例中有4例进行了术后X线检查，证实管尖正确置于胃内。基于我们的经验和既往报告，基于BT光的胃管尖端验证系统，即使用红色LED光来确认鼻胃管尖端位置，已被证明是实时验证幼儿鼻胃管位置的有效工具。
