Definition
It refers to assisting in the insertion of Sengstaken-Blakemore tube or Minnesota balloon which exerts pressure directly on bleeding sites in the esophagus and stomach.
Types of Tubes Used for Tamponade and their Parts
- A Sengstaken-Blakemore tube with the following parts:
- Oesophageal balloon
- Gastric balloon
- Gastric aspiration port.
A Minnesota tube with the following parts:
- Esophageal balloon
- Gastric balloon
- Gastric aspiration port
- Oesophageal aspiration port.
Purpose
To arrest acute bleeding from esophageal varices and stomach.
Articles
- Sengstaken-Blakemore tube or Minnesota tube.
- Curved artery forceps, tips protected with rubber tubing.
- Lubricant.
- Adhesive.
- Syringes.
- Gloves.
- Vaseline gauze.
- Basin with ice chips.
- Towel and emesis basin.
- Device to apply traction (optional).
- Large scissors (for emergency deflation).
- Manometer (to measure balloon pressure
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Explain the procedure and give psychological support to the patient. | Allays anxiety and helps in obtaining cooperation of the patient. |
| 2 | Elevate the head of the bed slightly unless the patient is in shock. | |
| 3 | During procedure Check balloon by trial inflation to detect leaks. | This is best done under water because it is easier to see escaping of air bubbles. |
| 4 | Chill the tube then lubricate it, before the physician passes it via mouth or nose. | Chilling makes the tube more firm and lubrication lessens friction. |
| 5 | Provide the patient with a few sips of water. | This will help in passage of the tube more easily. |
| 6 | Verify placement of tube in stomach by irrigating the gastric tube with air while auscultating over the stomach. | It is imperative that the tube is in the stomach so that the gastric tube is not inflated in the esophagus. |
| 7 | Obtain an X-ray film of the lower chest and upper abdomen to verify placement of tube in the stomach. Inflate gastric balloon with air and gently pull tube back to seat balloon against gastroesophageal junction. | Exerts pressure against cardiac sphincter. |
| 8 | Clamp gastric balloon tube and mark tube location at nares, | Prevents air leakage and tube migration. The mark on the tube allows easy visualization of movement of the tube. |
| 9 | Apply gentle traction to the balloon tube and secure it with a foam rubber cube at the nares. | Prevents the tube from migrating with peristalsis and assists in exerting adequate pressure. |
| 10 | Attach Y-connector to esophageal balloon opening. Attach syringe to one arm of the “Y” connector and manometer to the other. Inflate esophageal balloon to 25-35 mm Hg pressure lamp esophageal balloon. | Maintains enough pressure to tamponade bleeding while preventing esophageal necrosis. |
| 11 | Apply suction to gastric aspiration port and irrigate at least hourly. | Suctioning and irrigating the tube can remove old blood from the stomach and prevent hepatic encephalopathy and allows monitoring of bleeding status. |
| 12 | Insert a nasogastric tube, positioning it above the oesophageal balloon and attach to suction. If using a Minnesota tube, attach the fourth port (oesophageal suction port) to suction. | Nasogastric tube serves to check for bleeding and suctions saliva accumulated above the esophageal balloon. |
| 13 | After procedure a. Label each port. b. Tape a scissor at head of bed. | Prevents accidental deflation or irrigation. Airway occlusion may occur if the esophageal balloon is pulled into the hypopharynx. If this occurs, the esophageal ballon tube must be cut and removed immediately. |
Special consideration
- Maintain constant vigilance while balloons are inflated in the patient.
- Keep balloon pressures at required level to control bleeding.
- Observe and record vital signs, monitor color and amount of nasogastric lavage fluid for evidence of bleeding.
- Be alert for chest pain which may indicate injury or rupture of esophagus.
- Irrigate suction tube as prescribed, observe and record nature and color of aspirated material.
- Keep head of bed elevated to avoid gastric regurgitation and to diminish nausea and a sensation of gagging.
- Maintain nutritional and electrolyte level parenterally.
- Note nature of breathing, if counterweight pulls the tube into oropharynx, the patient may be asphyxiated
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
