Blue Dye Swallow Testing for Tracheostomy Patients; Guest Blog by Eric Blicker

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