Search

Introduction: Nasogastric tube (NGT) placement is a common procedure in pediatric intensive care and requires accurate verification to avoid complications. Traditional methods such as auscultation and radiography pose limitations such as unreliability and radiation exposure. The aim of this study was to confirm the placement of NGT using bedside ultrasonography (USG). Methods: A prospective study was conducted in a tertiary pediatric intensive care unit (PICU) using bedside USG to confirm NGT positioning. The study included 46 patients, with procedures ranging from November 2023 to January 2024. Placement confirmation techniques included USG visualization and the air bolus method when necessary. Results: All 68 NGT insertions were successfully visualized using USG. The median age of patients was 18 months, with the most common admissions being pneumonia and septic shock. An air bolus was used in 13.2% of the cases to indirectly confirm placement. Conclusion: Bedside USG is an effective and safe alternative for confirming NGT placement in the PICU, minimizing the risk of radiation, and leveraging the benefits of immediate and accurate bedside assessment. This method can replace radiography as the new standard for NGT placement confirmation.

Ashman phenomenon is an aberrant ventricular conduction seen in atrial fibrillation. It is due to a change in the length of QRS complex. It is most often mistaken for a premature ventricular contraction (PVC) or ventricular tachycardia. A 15-year-old male patient was admitted to the emergency department with the complaint of palpitation. He had a 3-year history of type 1 diabetes mellitus and he was using isotretinoin for nodular acne for 1 month. His heart rate was 195 beats/min and his electrocardiographic findings were compatible with supraventricular tachycardia (PVC). Adenosine was administered as an intravenous push twice, however, since atrial fibrillation did not return to normal sinus rhythm , he was transferred to our pediatric intensive care unit. After a transesophageal echocardiography showing no thrombus or structural defect, synchronized cardioversion was attempted at escalating doses of 0.5 J/kg, 1 j/kg and 1.5 j/kg dose, but the patient was unresponsive. After the cardioversion, the patient did not return to normal sinus rhythm hence re-evaluated with ECG again. Persisted tachycardia, absence of p waves, similar extra-ventricular beats and unequal R-R distances were observed. This rhythm was found to be compatible with atrial fibrillation and that the supraventricular pulses delivered with the accompanying aberration were Ashman’s phenomena. After infusion of 3 mg/kg, amiodarone was continued 6 mcg/kg/min as maintenance infusion. His rhythm went back to normal. Amiodarone infusion was discontinued at the 48th hour and the patient was transferred to pediatric cardiology service with oral propranolol treatment. The Ashman phenomenon is a very rare condition in childhood and should be distinguished from the series of PVC and sequentially identified supraventricular complexes, due to completely different treatment options.