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Gastric Ultrasound for Aspiration Risk Determination

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Gastric Ultrasound for Aspiration Risk Determination, GUARD

  • Indications
  1. Peri-Procedural Sedation Evaluation of aspiration risk
  2. Increased aspiration risk (e.g. Delayed Gastric Emptying)
    1. GLP1 Agonist use
    2. Gastroparesis
    3. Esophageal Stricture
    4. Third trimester pregnancy
    5. Recent large meal
  • Technique
  1. Patient lies supine
  2. Curvilinear Ultrasound probe positioned with indicator toward patient's head
    1. Identify the gastric antrum at the liver tip (anterior to aorta)
  • Interpretation
  • High Risk Aspiration Findings
  1. Solid food with complex appearance within the Stomach (supine position) OR
  2. Anechoic fluid present (supine) AND measuring >100 ml (right lateral decubitus)
    1. Patient rolls into the right lateral decubitus position
    2. Measure antral cross-sectional area
      1. Machine calculation based on tracing the antrum margins OR
      2. Calculate from the Anteroposterior and Craniocaudal measurements
  • Management
  1. Delay elective, non-emergent procedures if either of criteria present above
  • References
  1. Swaminathan and Derr (2026) GUARD, accessed 7/5/2026