Balloon tamponade for massive GI bleeding: Difference between revisions
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#Test tubes for leaks and inflate in 100 mL increments while measuring the pressure each time | #Test tubes for leaks and inflate in 100 mL increments while measuring the pressure each time | ||
#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 | ||
#Insert tube orally to at least 50 cm mark | #Insert tube orally to at least 50 cm mark | ||
# | #*Use lubrication and laryngoscope to aid in placement | ||
#Inject air into gastric port and listen over the stomach | #Inject air into gastric port and listen over the stomach | ||
# | #*If air is auscultated, inject 50 cc into gastric balloon and shoot CXR to confirm placement in stomach | ||
#Gastric aspiration port to continuous suction | #Gastric aspiration port to continuous suction | ||
#Completely fill gastric balloon | #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 | ||
#Place 1 kg traction on tamponade device and mark device at the lips | #Place 1 kg traction on tamponade device and mark device at the lips | ||
# | #*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 | ||
# | #*Hang 1 L bag over IV pole | ||
#Esophageal and gastric aspiration ports to suction | #Esophageal and gastric aspiration ports to suction | ||
#If bleeding continues inflate the esophageal balloon | #If bleeding continues inflate the esophageal balloon | ||
# | #*Inflate to 20-40 mm Hg | ||
# | #*Do not inflate more than 45 mm Hg | ||
==Complications== | ==Complications== | ||
Revision as of 14:02, 12 April 2015
Indications
- Unstable patients with massive upper GI bleed and
- Inability to perform endoscopy
- Endoscopy failure
- Delay in consultant presentation
- Need to transfer/stabilize
Contraindications
- History of esophageal stricture
- Recent esophageal or gastric surgery
Equipment Needed
- 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
Procedure
- Patient should be intubated prior to placement to decrease aspiration risk
- Test tubes for leaks and inflate in 100 mL increments while measuring the pressure each time
- 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
- Insert tube orally to at least 50 cm mark
- Use lubrication and laryngoscope to aid in placement
- Inject air into gastric port and listen over the stomach
- If air is auscultated, inject 50 cc into gastric balloon and shoot CXR to confirm placement in stomach
- Gastric aspiration port to continuous suction
- 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
- Place 1 kg traction on tamponade device and mark device at the lips
- 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
- Hang 1 L bag over IV pole
- Esophageal and gastric aspiration ports to suction
- If bleeding continues inflate the esophageal balloon
- Inflate to 20-40 mm Hg
- 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
- LITFL: Sengstaken-Blackmore and Minnesota Tubes
- EMCRIT: Blakemore Tube Placement for Massive Upper GI Hemorrhage
Sources
- Roberts & Hedges 41, pp 831-836