Gastric Point of Care Ultrasound
Last updated: 01/05/2023
- Gastric point-of-care ultrasound (POCUS) should only be used when the pretest probability of “full stomach” is uncertain.
- Ultrasonography can be used to assess gastric contents by placing the patient in supine +/- right lateral decubitus and scanning with a curvilinear probe to visualize the gastric antrum.
- The gastric antrum is the best target for assessing gastric contents as it dilates in a linear fashion with increased gastric volume and lies in a gravity-dependent location.
- The goal is to sort patients into two categories: (1) low risk of aspiration (Grade 0 or 1 antrum) or (2) high risk of aspiration (Grade 2 or solids).
Indications and Image Acquisition
Indications: when the pretest probability of “full stomach” is uncertain. For example, if the patient is unable to communicate fasting history accurately or is at risk for delayed gastric emptying (e.g., diabetes).
Contraindications: (1) when the presence of gastric contents is already known with reasonable confidence (e.g., a bowel obstruction or alternatively a patient with no gastrointestinal (GI) comorbidities); (2) altered upper GI anatomy (e.g., gastric banding or gastric resection).
It is important to identify the gastric antrum because the antrum dilates in a linear relationship with gastric volume. The antrum of the stomach is identified by the concurrent presence of the liver and abdominal aorta.1,2
- Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Can J Anaesth. 2018;65(4):437-48. PubMed
- Cubillos J, Tse C, Chan VW, et al. Bedside ultrasound assessment of gastric content: an observational study. Can J Anaesth. 2012;59(4):416-23. PubMed
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