Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ORIGINAL ARTICLES
The Sky Blue Method as a Screening Test to Detect Misplacement of Percutaneous Endoscopic Gastrostomy Tube at Exchange
Yutaka SuzukiMitsuyoshi UrashimaHideki YoshidaTsuyoshi IwaseToshiroh KuraShin ImazatoMichiaki KudoTomoyuki OhtaAkihiro MizuharaYutaka TamamoriHirohito MuramatsuYukio NishiguchiYorihiro NishiyamaMikako TakahashiShinji NishiwakiMasami MatsumotoSatoshi GoshiShigeo SakamotoNobuyuki UchidaMasashi IjimaTetsushi OgawaMakoto ShimazakiShinichi TakeiChikou KimuraSatoyoshi YamashitaTakao EndoMasato NakahoriAkihiko ItohToshiro KusakabeIzumi IshizukaTakao IiriShingo FukasawaYukitsugu ArimotoNobuaki KajitaniKazuhiko IshidaKoji OnishiAkihiko TairaMakoto KobayashiYasuto ItanoToshiya Kobuke
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JOURNALS OPEN ACCESS

Volume 48 (2009) Issue 24 Pages 2077-2081

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Abstract

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%).
Conclusion 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.

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© 2009 by The Japanese Society of Internal Medicine
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