title: Confirmation of gastric tube bedside placement with the sky blue method.
abstract: BACKGROUND
  The purpose was to review our experiences and determine if applying the sky blue method is reliable in confirming gastric tube (GT) placement in neonates.
  
  
  METHODS
  The study population consisted of 44 infants (55 placements) who were admitted to the Takeda General Hospital between April 2012 and March 2013 and who required GT exchange. The sky blue method using indigo carmine (IC) was indicated for planned tube exchange only. Diluted IC was injected into the gastric space via the old GT just before the tube exchange. The tube was exchanged using a standard method. Then, we checked whether the diluted IC could be collected through the new GT or not.
  
  
  RESULTS
  The reasons for GT placement were a gestational age of < 35 weeks in 31 (56.4%), poor sucking or swallowing disorders in 17 (30.4%), and respiratory disorders in 7 (12.7%) of the 55 placements. GT placement using the sky blue method was considered successful in 52 placements (94.4%), with the remaining 3 placements (5.6%) considered to be failures due to the inability to obtain IC from the gastric space. No adverse events were observed during the tube exchange period.
  
  
  CONCLUSIONS
  Based on the results, the sky blue method can be considered to be reliable method for the confirmation of GT placement. These results also suggest that the number of radiologic evaluations performed to confirm correct replacement of the GT in infants can be reduced in the future.
authors.affiliation: Takashi Imamura, Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: ima@fmu.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Imamura
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeda
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Shibukawa
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Suda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Aya
authors.initials: A
authors.lastname: Goto
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Nagasawa
mesh_terms: D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007203:Indigo Carmine; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007564:Japan; D008297:Male
chemical_list: D007203:Indigo Carmine
keywords: enteral nutrition; gastrointestinal intubation; indigo carmine; neonates; newborn infant