The Blue Dye Test involves using a small drop of blue food
coloring mixed with a bolus and to determine if there is aspiration by monitoring for blue food color in tracheostomy tube suction. This is done as augmented version to a traditional bedside swallow test. When this test is used alone, without FEES or MBS, there is heightened risk for a high false negative rate. Research has revealed that the bedside blue dye test is not able to recognize all tracheal aspiration found on modified barium swallow (MBS) (Peruzzi WT et al 2001). What does clinical experience suggest? Blue dye bedside swallow test alone only shows if aspiration is present or absent and this is not always accurate when in trace or small amounts. This method of testing doesn’t tell when aspiration is happening (before, during, after swallow). Blue dye test doesn’t show the route of bolus laryngeal penetration: ( anterior into larynx over epiglottic rim, posterior spillage over the arytenoid cartilage, lateral entry over the aryepiglottic folds), which potentially leads to the aspiration. FEES/MBS benefit with tracheostomy patient is identification of precise behaviors resulting in aspiration risk, before the aspiration happens. This is particularly important with compensatory techniques and postures. In contrast, with beside blue dye exam and no MBS/FEES,SLP may observe signs of aspiration risk and may get blue food color in suction. But, there is no specific information as to events leading up to aspiration. Blue dye test alone without FEES/MBS seems to be more of a screening measure. Blue dye test at bedside, may not likely show trace amounts of aspiration (Donzelli J et al. 2001). Clinical experience has shown that recurrent aspiration in trace amounts in ventilator weaning patients may create further pulmonary compromise and prolong weaning in certain cases. When using blue dye testing alone without FEES/MBS, clinical experience has shown that one consistency tested at a time can potentially allow for the identification of what consistency was aspirated, if there was nothing else given to the patient. When a clinician provides multiple consistencies at once with blue dye at bedside without FEES/MBS and there is aspiration, it could be more difficult to determine what portion of a particular bolus consistency was aspirated or which consistency was aspirated. The clinical practice of blue dye testing without FEES/MBS may also reveal positive aspiration that is not bolus related. The presence of blue dye in suction of the tracheostomy tube can also reflect aspiration of secretions. Clinical practice has shown, that use of FEES or MBS is critical in the complete assessment of patients with tracheostomy tubes. Dr Eric Blicker MA CCC-SLP.D BRS-S
Sheila Good
9/15/2014 12:16:44 pm
I recently started at a hospital that does not have FEES available. We are revising P&P for blue dye swallow test, and I am in a quandary about how best to do that. For those cases where it would be felt appropriate to "Screen" for gross aspiration with a blue dye test prior to or following videofluoroscopy for whatever reason, are there alternatives to to use of blue food coloring, and if so what else is now being used? I know FEES are performed with milk and pudding for color contrast, but is there anything that has proven to be consistent for coloration after mixing with saliva and entering trach? We used to use green color with FEES; would that be an option? Or would safety/toxicity issues with food color still contraindicate use? I am about ready to just "heave" this policy & procedure out, but I wonder if a particular case might come up that would warrant having something in place under particular circumstances. ????
Amy Reinstein
9/20/2014 12:31:33 pm
Unfortunately I am not aware of any substitute referenced in the literature at this time. But you bring up an important point. I will continue to search for an answer and let you know if I find anything.
Stephanie
10/28/2015 04:55:27 pm
Where did you located the Phagein Blue dye? I've been trying to locate possible vendors to order for Speech Department.
Cathy Walstrum
4/14/2016 10:25:36 pm
Hi Stephanie,
Michelle
3/30/2017 06:09:10 pm
Thank you the information was what I needed to know I don't think any one should administer more than one consistency unless during MBS I also think a RT should be close by Thank you again
Binay
12/19/2017 04:45:26 pm
how many time /how often can you administer Blue Dye test to single pts. Comments are closed.
|
Amy Reinstein, M.S., CCC - SLP
|