[Dysphagia] Blue Dye Test - Trach patients

[Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU (Jai Gupta)]

Hi,
Is blue dye so expensive? that we cannot afford on bottle per patient..
when during single admission for trachy we can spends 1000's of $'s in
ICU and trachy management. Also I think the cross contamination from BD
bottle will be far less then the contamination that occurs routinely in
medical rounds. If I am really short of blue dye I pour a little in the
cup with the consistenties I am going to try and leave the bottle and
the bag out. If I need to repeat I leave the bottle in pts room. Inspite
of all the evidence as rptd by Staci ..which every user should be
aware.. Mind you there are people who believe that MBS or FEES too is
not true representation of what goes on in reality so nothing is
foolproof and we all change when we are are studied. I still find BDT
useful in my clinical practise but I think best outcomes are when one
uses his experience and sees the overall status of the pt, oral, immune,
medical and resp. status and make appropriate clincial decisions. Even
when to do a BDT is an important decision..is the pt ready? I use BDT
when MBS or FEES is not possible (and that is usally the case) and I
have managed all my pts well with no complication of aspiration or cross
infection to the best of my knowledge.

Jai Gupta

-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Bill Connors
Sent: Friday, 20 July 2007 1:25
To: 'Staci Otto'; dysphagia at dysphagia.com; setaylor at ppmh.org
Subject: Re: [Dysphagia] Blue Dye Test - Trach patients

What a common sense approach to the infection issue.  The reliability
is an issue.

Bill Connors

-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Staci Otto
Sent: Thursday, July 19, 2007 10:51 AM
To: dysphagia at dysphagia.com; setaylor at ppmh.org
Subject: Re: [Dysphagia] Blue Dye Test - Trach patients

I find it a useful component of overall assessment, assuming you are
familiar with the literature regarding the use of Blue Dye not being
reliable-
a few of the citations are below
as far as infection, we just put small amounts of food coloring into
syringes for single patient use... or there are plenty of colored food
products on the shelves today that can be used- blue koolaid, blue
applesauce, there's even oreo cookies with blue middles

Simultaneous videofluoroscopic swallow study and modified Evans blue dye
procedure: An evaluation of blue dye visualization in cases of known
aspiration.

Brady SL, Hildner CD, Hutchins BF.

Marianjoy Rehabilitation Hospital, Wheaton, Illinois 60187, USA.

The reliability of the modified Evans blue dye (MEBD) test for the
detection of aspirated materials in patients with tracheostomy has been
questioned. The videofluoroscopic swallow study (VFSS) has been the
standard procedure used to detect aspiration, but there are known risks
and the VFSS is not always an available evaluation option for aspiration
detection. The purpose of the present study was to investigate the
visualization of blue tracheal secretions in cases of known aspiration
as documented by the VFSS. Twenty consecutive simultaneous MEBD study
and VFSS were completed on patients with tracheostomies at an acute
rehabilitation hospital. Overall, the MEBD showed a 50% false-negative
error rate. The MEBD identified aspiration in 100% of patients who
aspirated more than trace amounts but failed to identify aspiration of
trace amounts (0%).


Simultaneous Modified Barium Swallow and Blue Dye Tests: A Determination
of the Accuracy of Blue Dye Test Aspiration Findings Therese M.
O'Neil-Pirozzi, Deborah J. Lisiecki, Deborah K. Jack Momose, Jennifer J.
Connors, Mary P. Milliner 1Department of Speech-Language Pathology and
Audiology, Northeastern University, Boston, Massachusetts, USA 2,
Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA Abstract
The overall objective of this pilot study was to determine blue dye test
reliability and validity for the identification of aspiration of
secretions, food, and/or drink in 50 simultaneously administered blue
dye (BDT) and modified barium swallow (MBS) tests of tracheostomized
individuals. With the MBS as an objective test of aspiration, BDT
sensitivity and specificity identifying aspiration were less than 80%
and 62%, respectively. Certain tracheostomy tube conditions and food
consistencies were associated with more accurate BDT aspiration results
than others. Characteristics of the aspiration episodes, interpretation
of the results, and needs for further research are discussed


The modified Evan's blue dye procedure fails to detect aspiration in the
tracheostomized patient: Five case reports 
Sheri Thompson-Henry1    and Barbara Braddock1
(1) 	Continental Rehabilitation Hospital of San Diego, San Diego,
California, USA
(2) 	Continental Rehabilitation Hospital, 555 Washington Street,
92103 San Diego, CA, USA
Abstract  The modified Evan's blue dye procedure (MEBD) is a method of
performing tracheal suctioning of the patient through the tracheostomy
tube after administration of color-contrasted food and liquid. The MEBD
is done when radiographic or fiberoptic procedures are not available or
practical. In 5 tracheostomized patients, the MEBD does not detect
aspiration.


Simultaneous modified Evans blue dye procedure and video nasal
endoscopic evaluation of the swallow.

Donzelli J, Brady S, Wesling M, Craney M.

Otolaryngology Head and Neck Surgery, Limited, Carol Stream, Illinois,
USA.

OBJECTIVE: To investigate the results of the modified Evans blue dye
test (MEBD) aspiration detection rate to the video nasal endoscopic
examination of the swallow (VEES) during simultaneous studies with
direct viewing of the subglottis through the tracheostomy site opening
by means of endoscopy. STUDY DESIGN: Prospective, consecutive. METHODS:
Fifteen consecutive simultaneous MEBD and VEES studies were completed on
patients with tracheostomies at an acute care rehabilitation hospital
over a 4-month period. All patients were referred to the swallowing
center for a video nasal endoscopic examination who had known or
suspected dysphagia. RESULTS: Aspiration was present in 53% (8) of the
studies as documented by the VEES. The MEBD showed an overall 50%
false-negative error rate for the detection of aspiration as compared
with the VEES. The MEBD identified aspiration in 67% of patients who
aspirated more than trace amounts but failed to identify aspiration of
trace amounts (0%). CONCLUSION: The results of the current investigation
suggest that the MEBD, at best, should be viewed only as a screening
tool for the presence of gross amounts of aspiration in patients with a
tracheostomy.


Staci Otto MS CCC-SLP
Senior Speech Pathologist
Center for Childhood Communication
Children's Hospital of Philadelphia
215-590-7636
fax # 215-590-5641


>>> "Taylor, Sharla" <setaylor at ppmh.org> 07/19/07 9:33 AM >>>
Just wanting some comments on anyone's experiences with doing the Blue
Dye test with Trach patients and/or feeding patients on a ventilator. 
Thanks!

Sharla E. Taylor, M.Ed., CCC-SLP
Speech Language Pathologist
Phoebe Putney Memorial Hospital
setaylor at ppmh.org
office - (229)312-8616
pager - (229)312-0005- - pager #3382
fax - (229)312-8605



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