Dye in Enteral Feedings

American Association of Critical Care Nurses- April 2005 Download the .pdf

Expected Practice:

  • Dye should not be added to enteral feeding as a method for identifying aspiration of gastric contents.

Supporting Evidence

  • Research and case reports of aspiration have shown that dye in enteral feedings is not visually detectable in situations similar to aspiration pneumonia.1-4 A recent consensus statement on methods for identifying aspiration in critically ill patients recommended that dye be eliminated from enteral feeding since it lacks sensitivity for identifying aspiration of gastric contents.5
  • The addition of dye to enteral feeding has been associated with several adverse events, including gastric bacterial colonization and diarrhea, systemic dye absorption, and death.6-9 The FDA recently issued a Public Heath Advisory based on reports of toxicity and death associated with dye in enteral feeding, although a direct causal relationship has not yet been definitively confirmed.9 The majority of reported cases of toxicity and /or death occurred in patients with sepsis.
  • Use of glucose testing of tracheal aspirates,1,10 once proposed as a method for identification of gastric aspiration, is no longer recommended as a viable strategy.4

What You Should Do:

  •  Do not use dye in enteral feedings as a method for identifying pulmonary aspiration.
  • If your current practice includes use of dye in enteral feedings, consider forming a multidisciplinary task force (nurses, physicians, dieticians, respiratory therapists, clinical pharmacists) or a unit core group of staff to address the need for removing dye from enteral feedings at your institution.
  • Assure that written practice documents (e.g., policies, procedures or standards of care) about enteral feeding do not include the addition of dye.
  • Educate staff about the reasons for removal of dye from enteral feedings.

Need More Information or Help?

Talk with a clinical practice specialist for additional information / assistance at www.aacn.org then select PRN.

References:

  1.  Potts R, Zaroukian M, Guerrero P, Baker C. Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults. Chest. 1993;103:117-121.
  2. Thompson-Henry S, Braddock B. The modified Evan’s blue dye procedure fails to detect aspiration in the tracheostomized patients: Five case reports. Dysphagia. 1995;10:172-174.
  3. Metheny N, Dahms T, Stewart B, et al. Efficacy of dye-stained enteral formula in detecting pulmonary aspiration in intubated adults. Chest. 2002;122:276-281.
  4. McClave S, Lukan J, Stefater J et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Critical Care Medicine. 2005;33(2):324-330.
  5. McClave S, DeMeo M, DeLegge M, et al. North American Summit on Aspiration in Critically Ill Patients: Consensus statement. JPEN. 2002;26:S80-85.
  6. File T, Tan J, Thomson R et al. An outbreak of Pseudomonas aeruginosa ventilator-associated respiratory infection and the significance of gastric colonization preceding Nosocomial pneumonia. Infect Control Hosp Epidemiol. 1995;16:417-418.
  7. Maloney J, Halbower A, Fouty R et al. Systemic absorption of food dye in patients with sepsis (letter). N Engl J Med. 2000;343:1047-1048. 1 of 2 American Association of Critical-Care Nurses Issued 4/2005
  8. Bell R, Fishman S. Eosinophilia from food dye added to enteral feedings (letter). N Engl J Med. 1990;322:1822.
  9. Acheson D. FDA Public Health Advisory: Reports of blue discoloration and death in patients receiving enteral feedings tinted with the dye, FD&C Blue No. 1. FDA Web site. Accessed September, 29, 2003, http://www.cfsan.fda.gov/~dms/col-ltr2.html
  10. Metheny N, St.John R, Clouse R. Measurement of glucose in tracheobronchial secretions to detect aspiration of enteral feedings. Heart and Lung. 1998;27:285-292.

Other Articles of Interest:

  1. Maloney J, Metheny N. Controversy in using blue dye in enteral feedings as a method for detecting pulmonary aspiration. Crit Care Nurse. 2002;22:84-86.
  2. Aschenbrenner D. Drug Watch: Blue dye No. 1 advisory. AJN 2004;104:71.
  3. Maloney J, Ryan T, Brasel K, et al. Food dye use in enteral feedings: A review and a call for a moratorium. Nutr Clin Pract. 2002;17:169-181.