Balloon tamponade

Indications

Unstable patients with massive upper GI bleed and
- Inability to perform endoscopy
- Endoscopy failure
- Delay in consultant presentation
- Need to transfer/stabilize

Balloon device
- Sengstaken-Blakemore Tube
- Minnesota Tube
60 cc syringe
Padded(tape) kelly clamps
- Used to clamp gastric and esophageal balloon ports to maintain precise pressure/volume
Manometer
3-way connector device
NG tube (only for Sengstaken-Blakemore)
Kerlex
IV pole
1 L bag IVF

Patient should be intubated prior to placement to decrease aspiration risk
Test tubes for leaks and inflate in 100 mL increments while measuring the pressure each time
If using Sengstaken-Blakemore tube, secure NG tube to tamponade device with distal end of NG tube 3 cm proximal to esophageal balloon
- This will function as esophageal aspiration port
Insert tube orally to at least 50 cm mark
- Use lubrication and laryngoscope to aid in placement
Inject air into gastric port and listen over the stomach
- If air is auscultated, inject 50 cc into gastric balloon and shoot CXR to confirm placement in stomach
Gastric aspiration port to continuous suction
Completely fill gastric balloon
- Sengstaken-Blakemore: 250-300cc
- Minnesota: 450-500cc
- Measure the pressure at each 100 mL increment
  - If pressure is >15mm Hg more than corresponding pre-insertion pressure deflate the balloon and advance further prior to filling gastric balloon
Place 1 kg traction on tamponade device and mark device at the lips
- Tie one end of kerlex around the distal portion of tamponade device (proximal to port insertion sites) and attach other end to 1 L bag IVF
- Hang 1 L bag over IV pole
Esophageal and gastric aspiration ports to suction
If bleeding continues inflate the esophageal balloon
- Inflate to 20-40 mm Hg
- Do not inflate more than 45 mm Hg

Due to misplaced balloon, migration, overinflation, prolonged use
- Mucosal ulceration
- Aspiration
- Airway or large vessel obstruction
- Esophageal rupture