Gastroesophageal Balloon Tamponade and the Sengstaken–Blakemore Tube

imagesUnstable patients with gastroesophageal varices receiving maximal medical therapy


imagesEndoscopy is unavailable or unsuccessful


CONTRAINDICATIONS



imagesEsophageal strictures or recent gastroesophageal surgery


imagesRelative:


   imagesNo active bleeding


   imagesIncomplete equipment


   imagesSource of bleeding likely gastric



imagesGeneral Basic Steps


   imagesGather supplies


   imagesPrepare patient—intubate


   imagesPlacement and gastric balloon inflation


   imagesTraction


   imagesEsophageal balloon inflation


SUPPLIES



imagesSengstaken–Blakemore (SB) tube (triple lumen tube) or Minnesota tube (quadruple lumen tube). The fourth port is for suctioning the proximal esophagus.


imagesSalem Sump (double-lumen nasogastric tube) and silk ties to create necessary fourth lumen (not needed if using a Minnesota tube)


images60-mL Luer lock syringe


images60-mL Piston syringe


images2 Christmas tree catheter adapters


images2 Three-way stopcocks


images2 Heplock caps


imagesSurgilube


images1 Sterile gauze bandage roll (Kerlix)


images1 L NS (normal saline)


imagesKelly clamps (padded)


images2 wall-suction units


imagesStraight connector


imagesManual sphygmomanometer


TECHNIQUE



imagesPreparation


imagesSecure the airway. The patient will be intubated in almost all scenarios. Raise the head of the bed to 45 degrees.


imagesAssemble attachments to gastric balloon and esophageal balloon ports


imagesTest for air leaks using 60-cc Luer lock syringe


   imagesGastric balloon—Inflate 250-cc air


   imagesEsophageal balloon—Inflate 60-cc air


imagesDeflate the balloons completely


imagesIf using an SB tube, create fourth lumen:


   imagesPlace the distal tip of Salem Sump 2 cm proximal to the esophageal balloon and secure with silk ties (FIGURE 29.1)


imagesPlacement and Gastric Balloon Inflation


   imagesLubricate the gastroesophageal balloon tamponade (GEBT). Insert orogastrically so that the 50-cm mark aligns with the patient’s lip. Can insert nasally; however, the oral route is preferred (FIGURE 29.2).


   imagesConfirm placement via air insufflation through gastric port and auscultation for gastric sounds


   imagesConnect gastric port to 60 to 120 mm Hg intermittent suction. Inflate the gastric balloon with 50 cc of air.


   imagesConfirm with chest x-ray that the inflated balloon is in the stomach


   imagesInflate additional 200 cc of air into gastric balloon, for a total of 250 cc of air


   imagesAffix padded Kelly clamp to gastric balloon port


imagesTraction


   imagesThe proximal end of the GEBT needs to be secured with traction


   imagesAttach Kerlix distal to SB tube ports by creating a slip knot. Secure the opposing end to 1-L NS bag (or similar weight).


   imagesHang Kerlix over the IV pole, allowing the 1-L NS bag to hang freely, applying traction to the SB tube


imagesEsophageal Balloon Inflation


   imagesConnect sphygmomanometer to the three-way stopcock on esophageal balloon port


   imagesInflate the esophageal balloon to 30 to 45 mm Hg (typically 50–70 cc air), using lowest pressure necessary



images


FIGURE 29.1 Modified Sengstaken–Blakemore tube. Also available is the Minnesota tube, which has a built-in esophageal port. (Reused with permission from Yamada T. Textbook of Gastroenterology. 4th ed. Vol 1. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:707.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Gastroesophageal Balloon Tamponade and the Sengstaken–Blakemore Tube
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