CICM SAQ 2015.2 Q30

a) What is the tube in the image above used for? (10% marks)

Minnesota tube (Sengstaken-Blakemore or gastro-oesophageal balloon tamponade device acceptable) for balloon tamponade of bleeding oesophageal varices.

b) Describe the steps for insertion of this tube. (40% marks)

• Intubate patient to protect airway and simplify insertion.
• Check balloon for leaks & lubricate tube.
• Pass via nares (or mouth if severe coagulopathy present) and guide under laryngoscopic control
  into oesophagus, until 50cm inserted.
• Slowly inflate gastric balloon: 250ml air.
• Gently withdraw tube until resistance felt (~30-35cm) as balloon engages with gastro-oesophageal
  junction.
• Aspirate both ports. Check volume of fresh blood: reducing?
• If bleeding has ceased (~80%) then leave oesophageal balloon deflated.
• Apply traction to tubing (as below)
• If bleeding from mouth or oesophageal aspiration port continues, then inflate oesophageal balloon
  with air to 25-30mmHg (max 40).
• Deflate oesophageal balloon for 10 min every 2-hrs.
• Apply traction to tubing by tying 500ml bag of fluid over pulley.
• Check position on CXR: identify gastric balloon below diaphragm & radio-opaque marker along
  course.

Or any acceptable technique

c) What are the contraindications for its insertion? (20% marks)

• Oesophageal stricture
• Recent oesophageal surgery
• Hiatus hernia
• Unknown cause of GI bleed

d) What are the complications of its use? (30% marks)

• Trauma to nose, pharynx, oesophagus
• Incorrect placement or dislodgement of gastric balloon in pharynx or oesophagus (may result in
  acute upper airway obstruction if airway not secured)
• Oesophageal tear or rupture
• Failure to control bleeding.
• Aspiration pneumonitis.
• Secondary infection: pneumonia, sinus
• Nasal or oral mucosal ulceration & necrosis from traction.