Esophageal balloon tamponade
Esophageal balloon tamponade | |
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Drawing of using the Blakemore tube. There is a manometer connected to the esophageal port, to enable inflating the balloon with correct pressure. | |
Contraindications | Recent esophageal surgery, esophageal stricture[1] |
Types | Sengstaken-Blakemore, Minnesota, Linton[2] |
Steps | 1) Intubate 2) Verify balloons intact 3) Place tube via the mouth 4) Verify placement by X-ray 5) Inflate stomach balloon 6) Apply traction 7) Inflate the esophageal balloon if needed[1] |
Complications | Airway obstruction, esophageal rupture[1] |
Esophageal balloon tamponade refers to the use of balloon tamponade in the esophagus and stomach.[1] This is generally carried out to treat bleeding from esophageal or gastric varices when other measures are not available or not successful.[1]
The most common cause of bleeding from varices is cirrhosis.[1] These devices are generally only used in people who are hemodynamically unstable.[1] Contraindications for placement include recent esophageal surgery or esophageal stricture.[1]
Preparation involves intubation followed by placing the person on their back at 45 degrees.[1] The device is than checked to make sure no leaks are present.[1] It is than placed via the mouth and 50 ml of air are added to the stomach balloon.[1] An X-ray is than done to verify placement and once confirmed more air is added.[1] Traction can than be applied.[1] Bleeding is than checked for, and if present the esophageal balloon may be inflated using a manometer.[1]
After placement, further treatment is required.[1] Complications can include airway obstruction, esophageal rupture, and aspiration pneumonia.[1] The procedure is rarely done.[1] The first device developed was the Sengstaken-Blakemore tube in the 1950s.[1] Other versions of the device include the Minnesota tube and the Linton tube.[1][2]
Medical use
When inserted balloon catheters are intended to stop bleeding from vascular structures—including esophageal varices and gastric varices—in the upper gastrointestinal tract. Balloon tamponade is considered a bridge to more definitive treatment.
It is estimated to be about 90% effective.[3]
Contraindications
Contraindications include recent esophageal surgery and esophageal stricture.[1] A hiatus hernia may make use more complicated.[1][4]
Technique
While there is slight variation between the types of tubes the general technique is:
- Intubate to protect the airway
- Verify that all balloons inflate and are intact
- Place the tube all the way in either via the mouth or nose and put in a bit of air
- Verify that the end of the tube is in the stomach by X-ray
- Inflate the stomach balloon and apply traction. This may be done by attaching a liter bag of normal saline over an intravenous pole.
- Often this is sufficient. If the esophageal balloon is inflated a manometer is required to verify that excessive pressures are not used
The esophageal balloon can have 40 cmH2O (30 mmHg) place in it.[1] If this is not enough 60 cmH2O (45 mmHg) may be used.[1]
Traction can then be applied, with a number of techniques described to maintain this.[5]
Equipment
There are three types of balloons manufactured for the purpose of tamponading upper gastrointestinal bleeds, each with different volume capacities and aspiration ports.
They include:
- Sengstaken-Blakemore tube, with three lumens (two balloons and a gastric aspiration port). Pressure can be applied to gastric and esophageal varices by balloon inflation and traction.[6]
- Linton tube, with a large gastric balloon, and gastric and esophageal aspirates
- Minnesota four-lumen tube, with esophageal and gastric balloons, and esophageal and gastric aspirates.
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A Blakemore tube
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Manometer used to inflate the esophageal balloon and verify that excessive pressures are not used
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A Blakemore tube inflated in the stomach
Society and culture
Instructions are available on how to make a training mannequin to practice placement.[7]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 Powell, M; Journey, JD (January 2021). "Sengstaken-Blakemore Tube". StatPearls. PMID 32644350.
- ↑ 2.0 2.1 "Esophageal Balloon Tamponade". fpnotebook.com. Archived from the original on 22 January 2021. Retrieved 15 March 2021.
- ↑ "Sengstaken–Blakemore and Minnesota Tubes • LITFL • CCC Equipment". Life in the Fast Lane • LITFL. 30 January 2019. Archived from the original on 24 January 2021. Retrieved 15 March 2021.
- ↑ Morgenstern, Justin (23 May 2016). "Balloon tamponade of GI bleeding". First10EM. Archived from the original on 7 March 2021. Retrieved 15 March 2021.
- ↑ Murphy, Evelyn Patricia; O'Brien, Sean Michael; Regan, Mark (20 March 2017). "Alternative method of tractioning the Sengstaken-Blakemore tube". BMJ Case Reports: bcr2016218401. doi:10.1136/bcr-2016-218401.
- ↑ "Sengstaken-Blakemore Tube Placement: Background, Indications, Contraindications". 2018-07-05. Archived from the original on 2019-06-05. Retrieved 2018-11-07.
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(help) - ↑ Young, TP; Kuntz, HM; Alice, B; Roper, J; Kiemeney, M (November 2017). "An Inexpensive Esophageal Balloon Tamponade Trainer" (PDF). The Journal of emergency medicine. 53 (5): 726–729. doi:10.1016/j.jemermed.2017.08.018. PMID 29128036. Archived (PDF) from the original on 2021-01-27. Retrieved 2021-03-15.
External links
- EMRAP Blakemore tube Archived 2021-08-29 at the Wayback Machine
- EMRAP Minnesota tube Archived 2021-08-28 at the Wayback Machine
- Life in the Fastlane Blakemore and Minnesota instructions Archived 2021-01-24 at the Wayback Machine
Classification |
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