INSERTION OF SENGSTAKEN-BLAKEMORE (SB) TUBE BALLOON TAMPONADE – Definition, Purpose, Equipment, Procedure and Post-Procedural Care
DEFINITION
Exerting pressure directly on bleeding sites in esophagus and stomach by using SB tube
PURPOSE
To arrest acute bleeding from esophageal varices and stomach
EQUIPMENT
- Sengstaken-Blakemore tube
- Curved artery forceps to be protected with rubber tubing, lubricant adhesive, tincture, benzoin, syringes, gloves, Vaseline gauze
PROCEDURE
- Explain procedure to patient and relatives
- Place the patient in supine position
- Pass SB tube through nose into stomach with balloons deflated
- After tube reaches stomach inflate gastric balloon with 100-300 ml of air and clamp lumen
- Pull out tube gently till balloon is held tightly against cardioesophageal junction
- Secure tube to face with adhesive after placing gauze around nostril
- Check for further hematemesis
- Inflate esophageal balloon (20-45 ml of air) and clamp
- Aspirate all blood from stomach, since blood products breakdown into ammonia which may precipitate hepatic coma
- Document time, procedure and amount of blood aspirated
POST-PROCEDURAL CARE
- Be aware of pressure exerted by inflated balloons
- Monitor vital signs every 15 minutes
- Reassure patient and relative
- As soon as bleeding has been controlled, transfuse whole blood to prevent hypovolemic shock
- Provide frequent mouth care
- Clean nostrils and lubricate
- Encourage passive exercises
- Administer antibiotics
- If gastric balloon ruptures, esophageal balloon is deflated at once and entire tube is removed
- Look for complications like rupture, erosion of esophagus, occlusion of airway by balloon and aspiration of secretions
- Document level of consciousness, time, whether gastric/esophageal balloon is inflated, amount of gastric aspiration and irrigation and vital signs
