CI: Blue Dye Use (2006)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

Comparison of efficacy of two most commonly recommended methods of detecting aspiration in tube-fed patients:

  • Adding dye and observing its presence in tracheobronchial secretions
  • Using glucose oxidase reagent strips to test tracheobronchial secretions for glucose-containing enteral formula. 
Inclusion Criteria:

Not applicable

Exclusion Criteria:

Not Applicable

Description of Study Protocol:



Literature review of bedside methods for detecting aspiration in Tube-fed patients. 13 papers were reviewed, based on the references cited. Methods used to locate and include relevant studies not clearly stated. Authors do note that only isolated reports of use of dye method available and that some are anecdotal, others small clinical studies which have not been replicated.

Statistical Analysis

This review cites statistics from individual papers but does not combine results into one analysis.

Data Collection Summary:

Not applicable

Description of Actual Data Sample:

Not applicable

Summary of Results:

Potential problems with dye methods

  • Low sensitivity
  • Long-term effects of food dye in tube-fed patients unknown and no safe amount established
  • Patient may become discolored
  • False-positive tests for blood in stool and gastric fluid
  • Difficulty reading pH paper when testing for gastric acidity
  • False-positive readings on glucose oxidase strips
  • Formula contamination due to colonization of dye in bottles
  • Allergic reactions
  • Blocking of cyclic guanosine monophosphate by methylene blue.

Risk-benefit ratio of bedside aspiration methods questioned in regards to:

  • Harm from use?
  • Sensitivity?
  • Specificity?
  • Potential benefit worth risk and cost?

If dye method used, must be evaluated scientifically. No current method appropriately sensitive and specific.


Author Conclusion:
  • Dye method is far less sensitive than the glucose reagent method
  • Anecdotal reports describe potential harm to patient when dye is added to feeding.
Funding Source:
University/Hospital: St Louis University, Washington University
Reviewer Comments:


Only results of the dye evaluation are reviewed here.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes