The Use of a Biologically Transparent Illumination Guide to Detect Gastric Tube Tip Position in Young Children From Diverse Clinical Backgrounds.

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.