Oesophageal Tamponade Tube

Oesophageal Tamponade Tube

Oesophageal varices arise as a result of portal hypertension. Bleeding oesophageal varices are associated with significant risk of mortality. Definitive management includes endoscopic sclerotherapy/banding +/- octreotide or transjugular intrahepatic portosystemic shunt (TIPS).

Indication:

1. Bleeding oesophageal varices
2. Failure of sclerotherapy/banding +/- octreotide to control bleeding
3. Delay or lack of availability of endoscopic intervention

Sengstaken –Blakemore (Minnesota modification) 4 channel tube:
Gastric Balloon
Gastric aspiration lumen
Oesophageal balloon
Oesophageal aspiration lumen

Policy guideline

The decision to insert a tube is made with consultation with the duty consultant intensivist and the duty consultant gastroenterologist/ general surgeon
All patients are to be endotracheally intubated prior insertion of Sengstaken-Blakemore tube
All patients are to be managed in the ICU
Risk of rebleeding after balloon insertion is 50%, all patients should undergo subsequent endoscopy and sclerotherapy after tube is removed.

Procedure

Check tube before insertion
Inflate the gastric balloon with 300 ml air, check and record the pressure in the in inflated gastric balloon
Inflate the oesohageal balloon with air, check and record the pressure in the inflated oesophageal balloon
Deflate both balloons completely and lubricate the tube
Insert tube orally under direct vision, using a laryngoscope; pass the tube to the 50-cm mark.
Do not inflate gastric balloon until correct tube placement is confirmed with X-Ray
Aspirate gastric lumen
Inflate gastric balloon with 300 ml of air, check the pressure in the gastric balloon, this should not exceed the pre insertion pressure by > 5 mmHg if the tube is correctly placed in the stomach. Higher pressures may indicate incorrect oesophageal placement, if high pressures present deflate balloon and repeat insertion and check X-Ray
Pull back tube until resistance is felt when the inflated gastric balloon rests in gastric fundus and against the oesophageal gastric junction
Apply traction (0.5-1kg) to the tube, i.e. 500ml or 100ml bag of fluid by pulley and cord
Inflate oesophageal balloon to a pressure of 35-40 mmHg
Recheck the position of the tube with X-Ray
Place on free drainage oesophageal and gastric lumens, and aspirate hourly or prn. Record aspirate and drainage volumes hourly to assess haemorrhagic losses
Balloons should not be inflated for > 24 hours

Contraindications:

. Known oesophageal stricture

. Unidentified source of bleeding

. Unprotected airway

Complications.

. Cardiac arryythmias
· Acute upper airway obstruction
· Oesophageal necrosis / rupture
· Aspiration pneumonia

The Sengstaken-Blakemore tube permits tamponade of both the distal esophagus and the gastric fundus. An accessory nasogastric tube permits aspiration of secretions from above the esophageal balloon.