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

12/14/2013

6 Comments

 
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

6 Comments
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. ????

Reply
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.

Reply
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.

Reply
Cathy Walstrum
4/14/2016 10:25:36 pm

Hi Stephanie,

We used Phagein Blue Dye and liked the fact that it was all natural. Our hospital was taken over by a larger hospital and the new hospital asked the dye company to fill out legal paperwork to have it entered into our ordering system. They delcined, so we can't use the product. Currently, I go and buy regular blue food coloring, blue Gatorade or green jello when we can't get a patient down to radiology for a VFSS.

Reply
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

Reply
Binay
12/19/2017 04:45:26 pm

how many time /how often can you administer Blue Dye test to single pts.

Reply



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  • Home
  • About Us
  • Speech Store
    • Free SLP Downloads
  • Dysphagia
    • The Normal Swallowing Process
    • Brain & CN's
    • Guidelines for Safe Swallowing
    • Imaging Examinations
    • Dysphagia Diagnosis
    • Liquids
    • Dysphagia Diets
    • Oral Care/Oral Hygiene
    • Predictors of Aspiration Pneumonia (AP)
    • Dysphagia Treatment Strategies >
      • Tube Feeding
  • Language
    • Developmental Milestones
    • Early Language Learning
    • Enhance Your Child's Communication
  • Aphasia
    • Symptoms of a Stroke
    • Language After Stroke
    • Aphasia Treatment
  • Feeding
    • Oral Motor
    • GI Disorders in Pediatric Feeding
    • Drooling
  • Autism
    • Therapy
    • Sensorimotor
    • Stimulation
  • Articulation vs Phonological
    • Speech Sound Development
    • Articulation Therapy Materials
  • Literacy
    • Reading
    • Processing Disorders
    • Writing
    • Enhance Literacy
    • Literacy Treatment
    • Phonemic Awareness Treatment
  • Voice
    • Voice Tips
    • Voice Therapy
    • Voice Modifications
  • Motor Speech Disorders/Dysarthrias
    • Classifications of the Dysarthrias
  • Stuttering
    • Normal Fluency Development
    • Enhance Fluency at Home
    • Deal with Stuttering Effectively
  • Treatment
    • Speech Therapy Material Links >
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      • Word Finding Strategy
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