- a) What is the tube in the image above used for? (10% marks)
- b) Describe the steps for insertion of this tube. (40% marks)
- c) What are the contraindications for its insertion? (20% marks)
- d) What are the complications of its use? (30% marks)
Answer and interpretation
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
- 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
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.
- Pass rate: 79%
- Highest mark: 9.3
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.