173: Bedside Percutaneous Ultrasound Gastrostomy in Critically Ill Patients With COVID-19

INTRODUCTION: COVID-19 inundated a major urban academic medical center with critically ill patients in the Spring 2020 A subset of these patients required long term enteral nutrition, leading to requests for gastrostomy tube placement Prior to this study, gastrostomy tubes were predominantly performed by Interventional Radiologists (IR) in fluoroscopy suites A portable gastrostomy method was needed to mitigate transportation and system risks involved with COVID-19 patients Percutaneous Ultrasound Gastrostomy (PUG) is a novel procedure using ultrasound to perform bedside gastrostomy The study aimed to evaluate the safety and feasibility of PUG at the bedside and in the IR suite We hypothesized PUG would be safe and effective for patients and reduce transportation and system risks inherent to COVID-19 patient care METHODS: IRB approval was granted to conduct a prospective, non-randomized, non-blinded observational study of the PUG using the PUMA-G System Patients referred for initial gastrostomy within BMI range of 20-35 with no presence of a pacemaker or history of prior gastrectomy or esophagectomy Patients were followed for complications until discharge or up to 30 days following PUG RESULTS: 18 patients with COVID-19 admitted to the ICU underwent PUG 7 and 12 attempts were made at the bedside and angiosuite, respectively Technically successful placement of PUG was achieved in 94% of patients (17/18) One patient was unsuccessful at the bedside and was completed in IR after indwelling nasogastric tube location was identified with repeat radiograph One attempt was aborted due to difficulty passing the orogastric balloon by a tracheostomy tube No complications associated with the g-tube were observed No providers developed COVID-19 symptoms following performance of PUG CONCLUSIONS: PUG is a safe and feasible means of performing bedside gastrostomy in critically ill patients Furthermore, in COVID-19 patients, PUG aids in reducing viral transmission across hospital areas, reduces PPE and janitorial utilization These results suggest that physicians skilled in ultrasound can adopt PUG as routine care at the bedside