Podcast 1026: Esophageal Balloon Tamponade Devices

Contributor: Jeffrey Olson, MD

Educational Pearls:

 

What are they?

• A flexible balloon and suction tube that we insert into the esophagus and into the stomach to stop bleeding.

When to use?

• Typically used for variceal bleeding. Use whenever the patient is too unstable to be transferred to more definitive therapy.

What are the different types?

• Linton - Nachlas Tube

• Single gastric balloon with a suction port for the stomach and sometimes a suction port for the esophagus.

• Sengstaken - Blakemore Tube

• Gastric balloon and esophageal balloon with only a gastric suction port

• Minnesota Tube

• Both gastric and esophageal balloon and both gastric and esophageal suction ports

How do you place one?

• Before placement

• Secure the airway first in a patient with massive ongoing hematemesis

• Insertion

• Fully lubricate the tube.

• Remove the white caps from the gastric and esophageal inflation ports.

• Test your balloons by placing them in the water and inflating them using your syringe.

• Place your three-way stopcocks on your esophageal and gastric inflation ports.

• Insert the tube similar to an OG tube until you have reached the 50 cm mark for the gastric balloon 

• Use a slip syringe at the gastric aspiration site and auscultate to confirm that you are in the stomach. Then fill the gastric balloon with 50 cc of air.

• Verify the placement of the gastric balloon with a chest x-ray. (You can also pre-check with ultrasound)

• Fully inflate the gastric balloon

• Blakemore: 250ccs

• Minnesota: 450-500ccs

• Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1L bag of IV fluids. Then hang the roller bandage over an IV pole.

• Place the nasogastric tube down to the pre-measured level above the gastric balloon and suction the esophageal space. If there is continued bleeding coming from the nasogastric tube then you will need to inflate the esophageal balloon.

• Note that Minnesota tubes already have their own esophageal suction port and will NOT need this NG tube placement to suction the esophagus.

• Use a "manometer" to in