- 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