The sky blue method as a screening test to detect misplacement of percutaneous endoscopic gastrostomy tube at exchange.
BACKGROUND
During tube exchange for percutaneous endoscopic gastrostomy (PEG), a misplaced tube can cause peritonitis and death. Thus, endoscopic or radiologic observation is required at tube exchange to make sure the tube is placed correctly. However, these procedures cost extensive time and money to perform in all patients at the time of tube exchange. Therefore, we developed the "sky blue method" as a screening test to detect misplacement of the PEG tube during tube exchange.


METHODS
First, sky blue solution consisting of indigocarmine diluted with saline was injected into the gastric space via the old PEG tube just before the tube exchange. Next, the tube was exchanged using a standard method. Then, we checked whether the sky blue solution could be collected through the new tube or not. Finally, we confirmed correct placement of the tube by endoscopic or radiologic observation for all patients.


RESULTS
A total of 961 patients were enrolled. Each tube exchange took 1 to 3 minutes, and there were no adverse effects. Four patients experienced a misplaced tube, all of which were detectable with the sky blue method. Diagnostic parameters of the sky blue method were as follows: sensitivity, 94% (95%CI: 92-95%); specificity, 100% (95%CI: 40-100%); positive predictive value, 100% (95%CI: 100-100%); negative predictive value, 6% (95%CI: 2-16%).


CONCLUSIONS
These results suggest that the number of endoscopic or radiologic observations to confirm correct replacement of the PEG tube may be reduced to one fifteenth using the sky blue method.
Suzuki
Yutaka
Y
Department of Surgery, International University of Health and Welfare, Otawara.
Urashima
Mitsuyoshi
M
Yoshida
Hideki
H
Iwase
Tsuyoshi
T
Kura
Toshiroh
T
Imazato
Shin
S
Kudo
Michiaki
M
Ohta
Tomoyuki
T
Mizuhara
Akihiro
A
Tamamori
Yutaka
Y
Muramatsu
Hirohito
H
Nishiguchi
Yukio
Y
Nishiyama
Yorihiro
Y
Takahashi
Mikako
M
Nishiwaki
Shinji
S
Matsumoto
Masami
M
Goshi
Satoshi
S
Sakamoto
Shigeo
S
Uchida
Nobuyuki
N
Ijima
Masashi
M
Ogawa
Tetsushi
T
Shimazaki
Makoto
M
Takei
Shinichi
S
Kimura
Chikou
C
Yamashita
Satoyoshi
S
Endo
Takao
T
Nakahori
Masato
M
Itoh
Akihiko
A
Kusakabe
Toshiro
T
Ishizuka
Izumi
I
Iiri
Takao
T
Fukasawa
Shingo
S
Arimoto
Yukitsugu
Y
Kajitani
Nobuaki
N
Ishida
Kazuhiko
K
Onishi
Koji
K
Taira
Akihiko
A
Kobayashi
Makoto
M
Itano
Yasuto
Y
Kobuke
Toshiya
T
D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D007203:Indigo Carmine