Esophagastric Tamponade Tube

1.  Wash hands and don personal protective equipment.
2.  Attach the gastric balloon port to the sphygmomanometer or pressure gauge.
3.  Test the tamponade tube balloon integrity.
4.  Insert a nasogastric tube, lavage the stomach, and remove tube.
5.  Lubricate balloons and distal 15 cm of tube with water-soluble lubricant.
6.  Apply the topical anesthetic agent to the posterior oropharynx (and nostril if nasally inserted).
7.  Insert oral airway or bite-block.
8.  Insert tube into mouth or selected nostril and advance into stomach to at least the 50-cm mark on the tube or 10 cm beyond the estimated length needed to reach the stomach.
9.  Lavage stomach via gastric suction port with NS until clear of large blood clots.
10. Connect gastric suction port to intermittent suction at 60 to 120 mm Hg.
11. Connect esophageal suction port to intermittent suction at 120 to 200 mm Hg (Minnesota tube only).
12. Confirm tube placement.
  a.  Aspirate drainage from gastric suction port.
  b.  Slowly inflate the gastric balloon with increments of 100 ml of air, up to a total 500 ml, observing the pressure on the sphygmomanometer or pressure gauge at each increment. (If the pressure exceeds preinflation pressure for a particular volume by more than 15 mm Hg, withdraw all of the air and advance tube an additional 10 cm.)
  c.  Upon full inflation of the gastric balloon, clamp the gastric balloon lumen with a rubber-shod clamp. Obtain abdominal x-ray.
13. Upon x-ray confirmation of placement, withdraw the tube until slight resistance is met and double-clamp with rubber-shod clamp.
14. Place tape marker around tube as it exits the mouth or nose.
15. Inflate esophageal balloon if bleeding is not controlled by gastric tamponade.
  a.  Clamp the tube and disconnect the sphygmomanometer or pressure gauge from the gastric balloon port and attach it to the esophageal balloon port.
  b.  Gradually inflate the esophageal balloon to 25 to 45 mm Hg.
  c.  Double-clamp esophageal balloon port with rubber-shod clamps.
16. If bleeding has not stopped, apply gentle traction on the tube.
17. Place the head of the bed at 30 to 45 degrees.
18. Insert a nasogastric tube to just above esophageal balloon. (Sengstaken-Blakemore tube only).
  a.  Secure the nasogastric tube to the tamponade tube with a suture where it exits the mouth.
  b.  Connect to intermittent suction 120 to 200 mm Hg.

Discontinuing Tamponade Therapy

20. Discontinue tamponade therapy in stages.
  a.  Deflate esophageal balloon by unclamping the esophageal balloon port and aspirating with an irrigation syringe to actively deflate the balloon.
  b.  Observe for the recurrence of bleeding over 24 hours. If bleeding recurs, reinflate the esophageal balloon.
  c.  If no further bleeding is noted, deflate the gastric balloon by unclamping the gastric balloon port and aspirating with an irrigation syringe to actively deflate the balloon.
  d.  Observe for the recurrence of bleeding over 24 hours. If bleeding recurs, reinflate the gastric balloon.
21. If bleeding has not recurred in 24 hours, cut the balloon lumens with scissors and remove tube slowly.
22. Document in patient record.
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