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Esophageal Balloon Tamponade
Aka: Esophageal Balloon Tamponade, Sengstaken-Blakemore Tube, Linton Tube, Minnesota tube, Blakemore Tube, Esophagogastric Balloon Tamponade
- See Also
- Variceal Bleeding
- Indications
- Esophageal Varices with Exsanguination
- Stabilize until emergent endoscopy
- Precautions
- Emergent endoscopy is preferred if immediately available
- Contraindications
- Esophageal Stricture
- Recent esophageal or gastric surgery
- Mechanism
- Balloons inflated within Stomach and esophagus
- Applies direct pressure on bleeding Varices
- Applies pressure to left gastric vein (supplies the esophageal venous plexus)
- Types
- Minnesota tube
- Linton Tube
- Sengstaken-Blakemore Tube
- Four proximal ports
- Gastric and esophageal balloon ports
- Gastric esophageal port (central at proximal end)
- Esophageal aspiration port (2-3 cm below the level of the other ports, along the tube)
- Long esophageal balloon
- Short Stomach balloon
- Nasogastric Tube type distal ports for gastric aspiration
- Technique: Sengstaken-Blakemore Tube Technique
- Preparation
- Gown and glove with full personal protectection equipment
- Endotracheal Intubation
- Secure airway
- Device
- Test balloons for air leaks prior to insertion
- Insertion
- Insert balloon device in same manner as a Nasogastric Tube and feed to the 50 cm mark
- Apply continuous suction to gastric port and esophageal port
- Gastric balloon
- Inject air into balloon while auscultating over Stomach
- Insert 50 cc air into gastric port
- Confirm positioning on XRay
- Gastric balloon must be in Stomach (not esophagus), otherwise risks Esophageal Rupture
- Further inflate gastric balloon
- Attach manometer using Y-Tube, and check pressure at every 100 cc of inflation
- Inflate gastric balloon to 250 cc by inserting another 200 cc
- Balloon filled with Contrast Media and water to allow for confirmation of tube position
- Marked increase in pressure may indicate tube displacement
- Secure Gastric Tube closure
- Apply clamp, red Rubber tubing or tape to gastric port (not hemostats)
- Apply traction to tube
- Apply counter-balance with the weight of IV fluid bag
- Secure the tube
- Use an Endotracheal Tube holder
- Evaluate for further bleeding
- Suction ports
- Inflate esophageal balloon to 30 mmHg (using manometer and Y-adapter) if bleeding persists
- May further inflate balloon to 45 mmHg if bleeding still persists
- Monitor for tube dislodgement
- Immediately cut tube to decompress
- Imaging
- Confirm tube placement with xray or Bedside Ultrasound
- Serial position checks are required to confirm gastric balloon remains in Stomach
- Efficacy
- Successful for stabilization in >60% of cases
- Complications
- Inability to control bleeding (resulting in death)
- Respiratory obstruction
- Aspiration Pneumonitis (if placed in non-intubated patient)
- Mucosal injuries (ulcerations of oral, esophageal or gastric mucosa)
- Tracheal rupture
- Duodenal rupture
- Esophageal Rupture
- References
- Sampson (2016) Crit Dec Emerg Med 30(4): 14-5
- Spangler, Swadron, Mason and Herbert (2016) EM:Rap C3, p. 8