Balloon tamponade for massive GI bleeding: Difference between revisions
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==Procedure==
==Procedure==
#Patient should be intubated prior to placement to decrease aspiration risk
#Intubate patient
#Test tubes for leaks and inflate in 100 mL increments while measuring the pressure each time
#Fully inflate and deflate each balloon using its respective port to check for leaks
#If using Sengstaken-Blakemore tube, secure NG tube to tamponade device with distal end of NG tube 3 cm proximal to esophageal balloon
#If using Sengstaken-Blakemore tube, secure NG tube to tamponade device with distal end of NG tube 3 cm proximal to esophageal balloon
#*This will function as esophageal aspiration port
#Use NG tube to measure 50 cm from top of gastric balloon on Sengstaken-Blakemore tube, and mark 'G'
#Insert tube orally to at least 50 cm mark
#Use NG tube to measure 50 cm from top of esophageal balloon on Sengstaken-Blakemore tube, and mark 'E'
#*Use lubrication and laryngoscope to aid in placement
#Attach 3-way stopcocks to esophageal and gastric ports
#Inject air into gastric port and listen over the stomach
#Insert tube orally (may need to use lubrication and Magill forceps) to > 50 cm
#*If air is auscultated, inject 50 cc into gastric balloon and shoot CXR to confirm placement in stomach
#Test for location in stomach by injecting air through the tube and auscultating at the epigastrium
#Gastric aspiration port to continuous suction
#Inflate gastric balloon (port marked 'G') with 50 mL of air
#Confirm location of gastric balloon in the stomach using portable XR
#Completely fill gastric balloon
#Completely fill gastric balloon
#*Sengstaken-Blakemore: 250-300cc
#*Sengstaken-Blakemore: 250-300cc
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#*Measure the pressure at each 100 mL increment
#*Measure the pressure at each 100 mL increment
#**If pressure is >15mm Hg more than corresponding pre-insertion pressure deflate the balloon and advance further prior to filling gastric balloon
#**If pressure is >15mm Hg more than corresponding pre-insertion pressure deflate the balloon and advance further prior to filling gastric balloon
#Place 1 kg traction on tamponade device and mark device at the lips
#Tie tube to casting sleeve/Kerlex attached to a 1L bag of normal saline, and hang bag over IV pole to provide 1 kg traction
#*Tie one end of kerlex around the distal portion of tamponade device (proximal to port insertion sites) and attach other end to 1 L bag IVF
#Attach esophageal and gastric aspiration ports to suction
#*Hang 1 L bag over IV pole
#If bleeding continues, inflate the esophageal balloon
#Esophageal and gastric aspiration ports to suction
#*Inflate to 20-40 mm Hg (use manometer to test pressure)
#If bleeding continues inflate the esophageal balloon
#*Inflate to 20-40 mm Hg
#*Do not inflate more than 45 mm Hg
#*Do not inflate more than 45 mm Hg


Revision as of 18:35, 12 May 2019

Indications

  • Unstable patient with massive upper GI bleed and any of the following:
    • Inability to perform endoscopy
    • Endoscopy failed (e.g., cannot visualize source due to heavy bleeding)
    • Delay in endoscopy or GI consultation
    • Need to stabilize prior to transfer

Contraindications

  • Esophageal stricture
  • Recent esophageal or gastric surgery

Equipment Needed

Sengstaken-Blakemore Tube.png
Sengstaken-Blakemore.png
  • Balloon device
    • Sengstaken-Blakemore Tube
    • Minnesota Tube
  • 60 cc syringe
  • Padded(tape) kelly clamps
    • Used to clamp gastric and esophageal balloon ports to maintain precise pressure/volume
  • Manometer
  • 3-way connector device
  • NG tube (only for Sengstaken-Blakemore)
  • Kerlex
  • IV pole
  • 1 L bag IVF
  • May need Magill forceps for manoeuvring tube into the esophagus

Procedure

  1. Intubate patient
  2. Fully inflate and deflate each balloon using its respective port to check for leaks
  3. If using Sengstaken-Blakemore tube, secure NG tube to tamponade device with distal end of NG tube 3 cm proximal to esophageal balloon
  4. Use NG tube to measure 50 cm from top of gastric balloon on Sengstaken-Blakemore tube, and mark 'G'
  5. Use NG tube to measure 50 cm from top of esophageal balloon on Sengstaken-Blakemore tube, and mark 'E'
  6. Attach 3-way stopcocks to esophageal and gastric ports
  7. Insert tube orally (may need to use lubrication and Magill forceps) to > 50 cm
  8. Test for location in stomach by injecting air through the tube and auscultating at the epigastrium
  9. Inflate gastric balloon (port marked 'G') with 50 mL of air
  10. Confirm location of gastric balloon in the stomach using portable XR
  11. Completely fill gastric balloon
    • Sengstaken-Blakemore: 250-300cc
    • Minnesota: 450-500cc
    • Measure the pressure at each 100 mL increment
      • If pressure is >15mm Hg more than corresponding pre-insertion pressure deflate the balloon and advance further prior to filling gastric balloon
  12. Tie tube to casting sleeve/Kerlex attached to a 1L bag of normal saline, and hang bag over IV pole to provide 1 kg traction
  13. Attach esophageal and gastric aspiration ports to suction
  14. If bleeding continues, inflate the esophageal balloon
    • Inflate to 20-40 mm Hg (use manometer to test pressure)
    • Do not inflate more than 45 mm Hg

Complications

  • Due to misplaced balloon, migration, overinflation, prolonged use
    • Mucosal ulceration
    • Aspiration
    • Airway or large vessel obstruction
    • Esophageal rupture

See Also

External Links

References

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