Today our topic of discussion is Insertion of Sengstaken Blakemore Tube Balloon Tamponade.
Insertion of Sengstaken Blakemore Tube Balloon Tamponade
INSERTION OF SENGSTAKEN-BLAKEMORE (SB) TUBE BALLOON TAMPONADE
Definition
Exerting pressure directly on bleeding sites in esophagus and stomach by using SB tube.
Purpose
To arrest acute bleeding from esophageal varices and stomach.
Equipment
- Sengstaken-Blakemore tube (Fig. 28.55)
- Curved artery forceps to be protected with rubber tubing, lubricant adhesive, tincture benzoin, syringes, gloves, Vaseline gauze.
Procedure (Fig. 28.56)
- Explain procedure to patient and relatives
- Place the patient in supine position
- Pass SB tube through nose into stomach with balloons deflated
- After tube reaches stomach inflate gastric balloon with 100-300 mL of air and clamp lumen
- Pull out tube gently till balloon is held tightly against cardioesophageal junction
- Secure tube to face with adhesive after placing gauze around nostril
- Check for further hematemesis Inflate esophageal balloon (20-45 mL of air) and clamp
- Aspirate all blood from stomach, since blood products breakdown into ammonia which may precipitate hepatic coma
- Document time, procedure and amount of blood aspirated.
Post-procedural Care
- Be aware of pressure exerted by inflated balloons
- Monitor vital signs every 15 minutes
- Reassure patient and relative
- As soon as bleeding has been controlled, transfuse whole blood to prevent hypovolemic shock
- Provide frequent mouth care.
- Clean nostrils and lubricate
- Encourage passive exercises
- Administer antibiotics
- If gastric balloon ruptures, esophageal balloon is deflated at once and entire tube is removed
- Look for complications like rupture, erosion of esophagus, occlusion of airway by balloon and aspiration of secretions
- Document level of consciousness, time, whether gastric/esophageal balloon is inflated, amount of gastric aspiration and irrigation and vital signs.
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