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
Contraindications
- 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
- May need Magill forceps for manoeuvring tube into the esophagus
Procedure
- Minnesota (at HUMC): https://www.youtube.com/watch?v=4FHIiA_doWU
- Blakemore: https://www.youtube.com/watch?v=NHelCd5Jtp4
- 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
Complications
- Due to misplaced balloon, migration, overinflation, prolonged use
- Mucosal ulceration
- Aspiration
- Airway or large vessel obstruction
- Esophageal rupture
See Also
Gastrointestinal Bleeding Pages
- Adults
- Pediatrics
External Links
- LITFL: Sengstaken-Blackmore and Minnesota Tubes
- EMCRIT: Blakemore Tube Placement for Massive Upper GI Hemorrhage