Balloon tamponade for massive GI bleeding

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

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

Intubate patient
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
Use NG tube to measure 50 cm from top of gastric balloon on Sengstaken-Blakemore tube, and mark 'G'
Use NG tube to measure 50 cm from top of esophageal balloon on Sengstaken-Blakemore tube, and mark 'E'
Attach 3-way stopcocks to esophageal and gastric ports
Insert tube orally (may need to use lubrication and Magill forceps) to > 50 cm
Test for location in stomach by injecting air through the tube and auscultating at the epigastrium
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
- 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
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
Attach esophageal and gastric aspiration ports to suction
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

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

Authors: