SANAANI, NUR-HATHI M

BSN-4A
29/07/2021

ATENEO DE ZAMBOANGA UNIVERSITY

COLLEGE OF NURSING

NURSING SKILLS OUTPUT

ESOPHAGOGASTRIC BALLOON TAMPONADE

TUBES BILLROTH 1 AND 11
GENERAL OBJECTIVE:
Acquisition and application of knowledge, skills and attitudes through the utilization
of nursing process and performance of professional management and leadership skills in
the care of sick adult clients with life-threatening conditions, acutely ill/ multi-organ
problems, high acuity and emergency situation toward health promotion, disease
prevention, restoration and maintenance and rehabilitation.

LEARNING OBJECTIVES:
.Establish rapport with the clinical instructor, co-student nurses and other members of the
health care team.
2.Participate actively in pre and post conferences.
3.Familiarize with the hospital system and environment:
a. Physical set-up
b. Policies and regulation
c. Organizational structure
d. Service and schedule of activities
e. Common nursing procedures and universal precautions
4.Correctly identify client and assist them with their needs.
5.Conduct an efficient nurse-patient interaction by using different therapeutic techniques.
6.Conduct cephalocaudal assessment appropriately to the patient.
7.Perform common nursing procedures correctly:
a. Vital signs
b. Bed making and morning care
c. Admitting and discharging patients
8.Gather accurate information for health history using Gordon’s 11 functional health
patterns.
9.Formulate a Nursing Care Plan using the 5 steps comprehensively and efficiently
formulate FDAR Charting.
10.Practice medical aseptic techniques such as hand washing, use of sterile gloves, face
masks, face shields and other PPE’s.
11.Implement and evaluate the nursing interventions.
12.Give health education appropriate to the patient’s needs.
13.Precisely reflect on the learning experience to improve my clinical skills and knowledge.
14.Document data correctly.
I. DESCRIPTION
Billroth I & II are both surgical procedure that involves resectioning
of the GI bowel tract. It is usually indicated for people experiencing
gastric ulcer, prepyloriculcer, early carcinoma, obstruction and many
more. Billroth I (BI) gastroduodenostomy is a procedure that can be
performed end-to-end or end-to-side. While the gastrojejunostomy in the
Billroth II (BII) repair is performed end-to-side. The critical distinction
between the BI and BII procedures is that in the BI reconstruction, the
duodenal channel is preserved, making it more difficult or impossible to
do prolonged gastrectomies. As a result, a BII or RY reconstruction should
be preferred for more extensive partial gastrectomy (Themes, 2016).
Regardless of how promising the method, both have unintended
repercussions. It was determined that two patients died as a result of
small-bowel perforations, resulting in an overall mortality rate of 1%
(2/185 operations) (Faylona et al., 1999).

To minimize significant complications, it is recommended that

health care practitioners and their teams focus on bleeding during Billroth
I repair and stump leaking during Billroth II reconstruction. Additionally,
be prepared for any perforations, as these require immediate surgical
attention (Cho et al., 2010). And one of the suggested procedures was
ever presented was the Balloon Tamponade. Balloon Tamponade is a
surgical technique that is only advised as a "bridge" to final therapy in
patients who have surgery and develop large or refractory
gastrointestinal bleeding, but is usually linked with re-bleeding and
serious consequences (Cárdenas et al., 2016). It is demonstrated that this
technique for gastrointestinal bleeding in an emergency setting has
considerable advantages and a favorable prognosis for the patient (Fleig
& Stange, 1982).
II. MATERIALS/EQUIPMENT
COMPONENTS

1.ESOPHAGOGASTRIC TAMPONADE TUBE (NOTE: COMMON NAMES OF THE

EGTT INCLUDE: SENGSTAKEN-BLAKEMORE TUBE, BLAKEMORE TUBE,
MINNESOTA TUBE)
2.EGTT TRAY MAY INCLUDE (OR STAFF MAY NEED TO ADD)
·1 BASIN
·FORCEP X2 WITH GAUZE TO PROTECT CLAMPED ITEMS
·PLASTIC Y CONNECTOR
·MANOMETER
3.GLOVES AND APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT (PPE)
4.TONSIL SUCTION SET UP
5.LOW INTERMITTENT SUCTION SET UP FOR 2 DRAINAGE PORTS – EITHER
SEPARATE OR Y CONNECTED
6.CATHETER ADAPTORS (CONNECTOR CONSISTING OF A LEUR LOCK
FEMALE END AND A GRADUATED END)
7.STOPCOCKS
8.SPHYGMOMANOMETER (MANUAL BLOOD PRESSURE CUFF MONITOR
WITH CUFF REMOVED)
9.60 ML CATHETER TIPPED SYRINGE
10.60 ML LEUR-LOCK SYRINGE
11.WATER-SOLUBLE LUBRICANT
12.MEASURING TAPE
13.500 ML BOTTLE NS FOR IRRIGATION
14.TAPE
15.SCISSORS
16.TO MAINTAIN ORDERED TRACTION TO ESTABLISHED EGTT:
·1 BEDFRAME SUPPORTING TRACTION PULLEYS; OR BED IV POLE AS
EQUIVALENT
·500GM/1 POUND WEIGHT OR 500ML NS BAG AS EQUIVALENT
·1KG/2 POUND WEIGHT OR 1000ML NS BAG AS EQUIVALENT
II. MATERIALS/EQUIPMENT
IMAGES
III. PROCEDURE
GUIDELINES OF Esophagogastric Tamponade Tube (EGTT): Assisting with Insertion,
Care and Removal

Established by: Winnipeg Regional Health Authority: Caring for Health

Approved: April 28, 2017 by Standards Committee Professional Advisory Committee

PREPARATION
If utilizing the oral route, intubation of the patient prior to the insertion is needed. If the
nasal route is being used the patient is not intubated, ensure that intubation supplies are
always available at the bedside. Scissors and an additional EGTT must always be
maintained at the patient's bedside. The EGTT must be withdrawn if any symptoms of
airway blockage are detected.

Adhere to Routine Practices, practice proper hand hygiene, and wear adequate PPE in
accordance with the PCRA. Transfer patient to a suitable bedframe, unless
contraindicated, position the patient supine with the head of bed greater than or equal to
30 degree. Baseline vital signs include the following: heart rate (HR); blood pressure (BP);
respiratory rate (RR); oxygen saturation (SpO2) and tidal volume (VT); and, if
appropriate, peak airway pressure. Secure that tonsil suction is set up at the bedside.

MEASUREMENT
EGTT should be measured from the nares or corner of the mouth (depending on the
desired insertion site) to the earlobe, and then to the tip of the xiphoid process. Then a dd
ten centimeters to the distance measured. Furthermore, using a piece of tape, mark the
EGTT at the specified length, or at a minimum of 50 cm is necessary, and then attach the
stopcock to the catheter adapter, and finally, connect the adaptor to the gastric balloon
port.

INSERTION AND PLACEMENT

Evaluate the location using a portable abdomen X-ray. The physician will next inflate the
gastric balloon with air until it reaches a total capacity of 250-500 mL (the normal
amount is 250 mL). The physician will then gradually decrease the amount of air in
EGTT until a little resistance is seen. Following that, tape the EGTT around the site of exit
from the mouth or nose to indicate its location. Going to follow that, another x-ray is
taken to ensure the gastric balloon stays fully inflated in the stomach. If bleeding persists,
help the physician in inflating the esophageal balloon to a maximum pressure of 61 cm of
H20 (45 mmHg) using the air from the stopcock connected manometer. The bulb is then
compressed again and again until bleeding is tamponade.
III. PROCEDURE
 REMOVAL
The EGTT should be deflated and removed in phases to allow for rebleeding evaluation.
Never collapse the gastroesophageal balloon while the esophageal balloon remains
inflated. Typically, the operation begins with unclamping the esophageal balloon port.
And then aspirate air from the balloon port in the esophagus. The physician will next
release the gastric balloon and remove both the traction and intermittent suction from the
EGTT. Prior to withdrawing the syringe and EGTT, clamp the balloon ports.

IV. DIAGRAM/ILLUSTRAIONS:
IMAGES
V. NURSING RESPONSIBILITIES:
BEFORE PROCEDURE

a.Assist physician as directed. Remove NG tube if present prior to insertion of the

Minnesota tube.

b.Adhere to Routine Practices, practice proper hand hygiene, and wear adequate PPE in
accordance with the PCRA.

c.Transfer patient to a suitable bedframe, unless contraindicated, position the patient

supine with the head of bed greater than or equal to 30 degree.

d.Baseline vital signs include the following: heart rate (HR); blood pressure (BP);
respiratory rate (RR); oxygen saturation (SpO2) and tidal volume (VT); and, if
appropriate, peak airway pressure. Secure that tonsil suction is set up at the bedside.

DURING PROCEDURE

a.Ensure patient has received adequate sedation to tolerate insertion of EGTT and
minimize agitation which may lead to balloon displacement.

b.Monitor continuously throughout procedure and document HR; BP; RR and SpO2 every
5 minutes.

c.Assist physician with topical anaesthetic application to posterior pharynx or nasal

passage (depending on planned insertion site).

d.Apply water soluble lubricant to distal 15 cm of the EGTT. Assist physician with
insertion of EGTT up to tape mark.

e.Assist physician with partial inflation of gastric balloon

f.Assist physician to inflate gastric balloon with air to total 250-500 mL.

g.Apply tape around EGTT at point of exit from mouth or nose to mark placement.
V. NURSING RESPONSIBILITIES:
AFTER PROCEDURE

a.Notify physician immediately if any signs of rebleeding occur.

b.Traction should never be withdrawn when inflating the esophageal balloon. Maintain
correct alignment and free hanging traction at all times. After the initial 24 hours, the
physician will review the patient's requirement for traction regularly.

c.Maintain patient with head of bed ≥ 30º (unless contraindicated).

d. Turning the patient is permitted as long as the traction alignment is maintained.
i.Notify your physician if the tube has moved 3 cm or more.

e.Every two hours, provide oral and nasal care.

f.If an esophageal balloon is inflated, monitor and document balloon pressure hourly.
i. If the balloon pressure in the esophagus is higher than (>) 34 cm of H2O
(25mmHg) and there are no symptoms of bleeding, help the physician in lowering
the balloon pressure by 7 cm of H2O (5 mmHg) every 3 hours.

ii.If the esophageal balloon is inflated, help the physician in completely deflating it
every six hours.

iii.Once the time limit has passed or if symptoms of rebleeding emerge, help
physician with balloon reinflation.

g.Suction should be applied intermittently to the gastric and esophageal suction lumens.
Evaluate drainage on an hourly basis.

i.Notify your physician if total drainage (excluding flushes) exceeds 100mL per hour.

h.Maintain the patency of the esophageal and gastric suction lumens by irrigation with 5-
10mL of NS every 2-4 hours or as needed for the esophageal suction lumen and 50mL of
NS every 30 minutes or as needed for the gastric suction lumen.

i.Procedures, ongoing monitoring, and patient tolerance should be documented in unit-

specific records, such as the Critical Care Flow sheet, the Integrated Progress Note, and,
if available, the Electronic Patient Record.
REFERENCE

Cárdenas, A., Morillas, R., Llop, E., & Villanueva, C. (2016). Esophageal balloon
tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A
multicenter randomized, controlled trial. Hepatology, 63(6), 1957–1967.
https://doi.org/10.1002/hep.28360

Cho, G. S., Han, S. U., Kim, W., Kim, H.-H., Kim, M.-C., Ryu, S. Y., Ryu, S. W., & Song, K.
Y. (2010). Comparison of Billroth I and Billroth II reconstructions after laparoscopy-
assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from
Korea. Surgical Endoscopy, 25(6), 1953–1961. https://doi.org/10.1007/s00464-010-1493-0

Faylona, Qadir, Chan, Lau, & Chung. (1999). Small-Bowel Perforations Related to
Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients with Billroth II
Gastrectomy. Endoscopy, 31(7), 546–549. https://doi.org/10.1055/s-1999-61

Fleig, W. E., & Stange, E. F. (1982). Upper gastrointestinal hemorrhage from downhill
esophageal varices. Digestive Diseases and Sciences, 27(1), 23–27.
https://doi.org/10.1007/bf01308117

ESOPHAGEAL TAMPONADE TUBE (MINNESOTA Tube) – ASSISTING WITH

INSERTION, CARE OF A PATIENT, ASSISTING WITH REMOVAL, Nursing Practice
Committee (2017) (testimony of Saskatoon Health Region).
https://www.saskatoonhealthregion.ca/about/NursingManual/1097.pdf

Themes, U. F. O. (2016, August 2). Distal Gastrectomy with Billroth I or Billroth Ii

Reconstruction. Basicmedical Key. https://basicmedicalkey.com/distal-gastrectomy-with-
billroth-i-or-billroth-ii-reconstruction/

Winnipeg Regional Health Authority: Caring for Health. (2017). CLINICAL PRACTICE
GUIDELINE Esophagogastric Tamponade Tube (EGTT): Assisting with Insertion, Care
and Removal Standards Committee Professional Advisory Committee. In EducationWeek.
https://professionals.wrha.mb.ca/old/extranet/eipt/files/EIPT-047.pdf

http://youtube.com/watch?v=NHelCd5Jtp4

NUR-HATHI M. SANAANI
JULY 29-31, 2021
STUDENT NAME
DATE

DR. CHRISTINE CELDRAN RN MN PHD OR WARD

CLINICAL INSTRUCTOR AREA ASSIGNED
REFERENCE

Cárdenas, A., Morillas, R., Llop, E., & Villanueva, C. (2016). Esophageal balloon
tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A
multicenter randomized, controlled trial. Hepatology, 63(6), 1957–1967.
https://doi.org/10.1002/hep.28360

Cho, G. S., Han, S. U., Kim, W., Kim, H.-H., Kim, M.-C., Ryu, S. Y., Ryu, S. W., & Song, K.
Y. (2010). Comparison of Billroth I and Billroth II reconstructions after laparoscopy-
assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from
Korea. Surgical Endoscopy, 25(6), 1953–1961. https://doi.org/10.1007/s00464-010-1493-0

Faylona, Qadir, Chan, Lau, & Chung. (1999). Small-Bowel Perforations Related to
Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients with Billroth II
Gastrectomy. Endoscopy, 31(7), 546–549. https://doi.org/10.1055/s-1999-61

Fleig, W. E., & Stange, E. F. (1982). Upper gastrointestinal hemorrhage from downhill
esophageal varices. Digestive Diseases and Sciences, 27(1), 23–27.
https://doi.org/10.1007/bf01308117

ESOPHAGEAL TAMPONADE TUBE (MINNESOTA Tube) – ASSISTING WITH

INSERTION, CARE OF A PATIENT, ASSISTING WITH REMOVAL, Nursing Practice
Committee (2017) (testimony of Saskatoon Health Region).
https://www.saskatoonhealthregion.ca/about/NursingManual/1097.pdf

Themes, U. F. O. (2016, August 2). Distal Gastrectomy with Billroth I or Billroth Ii

Reconstruction. Basicmedical Key. https://basicmedicalkey.com/distal-gastrectomy-with-
billroth-i-or-billroth-ii-reconstruction/

Winnipeg Regional Health Authority: Caring for Health. (2017). CLINICAL PRACTICE
GUIDELINE Esophagogastric Tamponade Tube (EGTT): Assisting with Insertion, Care
and Removal Standards Committee Professional Advisory Committee. In EducationWeek.
https://professionals.wrha.mb.ca/old/extranet/eipt/files/EIPT-047.pdf

NUR-HATHI M. SANAANI
JULY 29-31, 2021
STUDENT NAME
DATE

MS. CHRISTINE CELDRAN RN MN PHD OR WARD

CLINICAL INSTRUCTOR AREA ASSIGNED