Sengstaken-Blakemore Tube

General Definition:

The Sengstaken-Blakemore Tube is used to create a balloon tamponade for bleeding

esophageal varices. It consists of three major components:

(1) the gastric balloon

(2) the esophageal balloon
(3) the esophageal suction port

Like all other invasive procedures, be sure a signed consent has been obtained before
performing this procedure.

Indications:

• Acute life threatening bleeding from esophageal or gastic varices that does not
respond to medical therapy
• Acute life-threatening bleeding from esophageal varices or gastric varices when
endoscopic hemostasis and vasoconstrictor therapy are unavailable.

Contraindications:

• Recent surgery that involved esophagogastric junction

• Known esophageal stricture

Anesthesia:

• Topical anesthetic spray or jelly for oropharynx use – optional

• Intubation and sedation is recommended for most patients

Equipment:

Here at HCH we have a Blakemore Esophageal Set assembled which contains:

• Gastroesophageal balloon tamponade tube (003936) #13321 McKesson

• Y-Connector
• Mercury Manometer
• 60 cc Syringes
• Three curved carmalts – (tube clamps)
• One bandage scissor
In addition, you will need:

Water water-soluble lubricating jelly

A glass of water
Soft restraints may be needed.

Positioning:

Elevate the head of the bed 45 degrees and position the patient on the bed.
The left lateral decubitus position is an acceptable alternative position.

Placement of Tube:

• Using the 60 cc syringe, suction all the air from both the gastric and esophageal
balloons.
• Clamp the balloon ports or insert the plastic plugs into the lumens.
• Coat the balloons and the tip of tubing with water soluble lubricant.
• After spraying the nostrils with topical anesthetic. Instruct the patient to begin
drinking water. As the patient swollows water, pass the tube through the nostril to
at least the 50 cm mark.
• Check proper placement by irrigating the gastic aspiration port with water while
auscultating over the stomach. If correct tube placement is at all uncertain or if
time permits, obtain a portable chest x-ray.
• When the gastric balloon is correctly positioned in the stomach, inflate the
balloon with the full recommended volume of air (usually 200-250 cc) and clamp
the air inlet and pressure monitoring outlet. Pull the tube back gently until
resistance is felt against the diaphragm.
• Fix the upper end of the tube as it emerges from the nostril by a cuff of sponge
rubber and held in place by an adhesive band.
• Next, inflate the esophageal balloon.
• VERY IMPORTANT: DO NOT OVERINFLATE.
• The esophageal balloon should not be inflated greater than 40 mm Hg.
• Clamp or plug the lumen.
• Aspirate through the stomach tube all air, water and blood. If necessary during
this step, irrigate the tube and stomach continuously with 50 cc of water to
prevent clotted blood from plugging the tube.
• If after carefully lavaging the stomach for 30 minutes bright red blood continues,
you may increase the balloon pressure to 45 mm Hg.
• After bleeding has been controlled reduce the pressure in the esophageal balloon
by 5mm Hg every 3 hours until 25 mm Hg is reached without bleeding; this
pressure is generally maintained for the next 12-24 hours. If bleeding is
controlled, deflate the esophageal balloon for 5 minutes every 6 hours to help
prevent esophageal necrosis.
Once satisfactorily positioned, the tube is generally left in place for 24 hours. If bleeding
recurs, the gastric balloon and, if necessary the esophageal balloon may be reinflated for
an additional 24 hours.

Pearls of wisdom:

• Remember that your patient cannot swallow once the esophageal balloon has been
inflated. Instruct the patient to spit out saliva.
• Never inflate the esophageal balloon before the gastric balloon.
• Never overinflate the esophageal balloon.
• Keep a pair of scissors near the patient at all times in case the balloon migrates to
obstruct airway. The whole tube cab be cut and removed.
• Direct pressure from the tube can cause mucosal ulceration. Perform frequent
examinations to ensure that the tube is not placing excessive force on any given
surface
• Minor complications may include: pain, pharyngeal or gastroesophageal erosion
and ulcers, pressure necrosis of nose, lips or tongue, hiccups.
• The Blakemore tube is expensive ($220.). Treat it with care.