Jeffrey Marshall, MD
Attending Physician
University of Maryland Baltimore Washington Medical Center, United States
Disclosure information not submitted.
Jason Heavner, MD
Attending Physician
University of Maryland Baltimore Washington Medical Center
Glen Burnie, United States
Disclosure information not submitted.
Peter Olivieri, MD
Attending Physician
University of Maryland Baltimore Washington Medical Center
Glen Burnie, Maryland, United States
Disclosure information not submitted.
R Gentry Wilkerson, MD
Associate Professor
University of Maryland School of Medicine
Baltimore, Maryland, United States
Disclosure information not submitted.
Title: Percutaneous Ultrasound Gastrostomy (PUG) Reduces Time to Gastrostomy Tube Placement in the ICU
Introduction: Gastrostomy tube placement is the most common inpatient non-diagnostic gastrointestinal procedure with approximately 50% of all feeding tubes placed on the critically ill in the US. Current gastrostomy tube placement methods often require consultant services leading to delays in care. Percutaneous Ultrasound Gastrostomy (PUG) is a safe procedure enabling bedside gastrostomy placement by critical care providers, avoiding the need for consultant services. Prior studies have demonstrated PUG can be performed at the bedside by POCUS trained physicians with a comparable safety profile to other gastrostomy procedures.
Hypothesis: The objective of this study was to evaluate whether implementation of PUG decreased time to gastrostomy tube placement following indication in the ICU.
Methods: The PUG procedure was implemented at a single-center, 36-bed mixed ICU. Median time to placement of gastrostomy tubes pre-intervention was compared with time to PUG placements post-intervention via retrospective chart review. The pre-intervention time frame was June 1, 2019 - December 1, 2019. The PUG time frame was December 1, 2019 - March 31, 2020. Time to gastrostomy tube placement was measured from time of initial documentation of need to tube placement. Baseline medical conditions were compared using the Fischer’s exact test and the difference in time to G-tube placement between groups was calculated using the Independent samples Mann-Whitney U test.
Results: A total of 16 gastrostomy tubes were placed in the pre-intervention group and 13 PUGs in the intervention group. Baseline past medical conditions and indications for gastrostomy were similar across both groups. The most common indications were failed swallow (51.7%) and neurological conditions (48.3%). Median time to gastrostomy was 91.64 hrs (3.82 days) in the pre-intervention group compared to 19.68 hrs (0.82 days) in the PUG group (p=0.002).
Conclusions: PUG implementation decreased time to gastrostomy tube placement in a large, single-center ICU. Along with reduced time to placement, PUG performance by critical care physicians can be concomitantly performed with tracheostomy. These efficiencies may be associated with improved patient outcomes and reduced ICU LOS, though further study is needed.