Indication:Life-threateningvaricealhaemorrhagewithsignsofcirculatorycollapse
Equipment:
• ClinySengstaken-BlakemoreTube(Fig.1)• 50mlleurlocksyringesx1• 50mlCathetertipsyringex1• Woodentonguedepressorsx2• Tape• Visor• Lubricant(egOptilubeorKYjelly)
Procedure:
1. Ideallythepatient’sairwayshouldbesecuredwithendotrachealintubation2. Manuallyinspectthetubetoensureitisintact,testthegastricand
oesophagealballoonswith50mlofairanddeflatebothfully.3. Spigottheaspirationchannels.4. LubricatetheSengstaken-Blakemoretube.5. InserttheSengstaken-Blakemoretubetoatleast50cmviathemouthand
removetheguidewire.Ifthetubeisnotstraightitisnotpossibletoremovetheguidewire.Iftheguidewirecannotberemovedwitheasedonotproceedtostep6,pullbackthetubeto45cmsandtryagain.Ifunsuccessfulremovethetubeandattemptinsertionagain.
6. Inflatethegastricballoonwith300mlofair(Fig.2).Donotroutinelyinflatetheoesophagealballoon.*
7. Pullbackonthetubeagainstthegastroesophagealjunctionandsecureitatthepatient’smouthwithtonguedepressorsandtapetocreatetraction(Fig.3).
8. ArrangeanurgentportableCXRtoconfirmtheposition(Fig.4).9. Ifnotalreadyawareorpresent,urgentlycontactthegastroenterology
consultantoncallforGIbleedingtoarrangeendoscopy.10. Theinsertionshouldbeclearlydocumentedinthemedicalnotesincluding
thedistancethetubeisinsertedto.11. Ensurethatmedicaltreatment(withterlipressinandantibiotics),and
resuscitation(withIVfluidandbloodproducts)isongoingaspertheupperGIbleedprotocol.
*Iftheoesophagealballoonistobeinflated,thisshouldonlybedoneontheinstructionofagastroenterologist.Ifyouareinaremotecentrewithoutanon-callgastroenterologist,pleasecontactyourlocalTIPSScentreforsupportandadvice.
ProtocolforInsertionofaSengstaken-BlakemoreTube(SBT)
RemovalTheSengstaken-BlakemoreTubeshouldremaininsituuntilendoscopiccontrolofbleedingisobtainedorTIPSSprocedurehasbeencompleted.Thetubeshouldberemovedwithin24hour.
PostInsertionCare
1. Thepatientshouldbemonitoredcloselyforsignsofbleeding.2. Theoesophagealportshouldbeaspiratedhourly.Iffreshbloodisaspirated
pleasecontactseniormedicalstaffandthegastroenterologyteam.3. Thegastricportshouldbeleftonfreedrainage.Iffreshbloodisnotedplease
contactseniormedicalstaffandthegastroenterologyteam.4. Pleaseconfirmanddocumentthepositionofthetubeatthemouthhourly.If
thereisanychangepleasecontactseniormedicalstaffasthetubemayhaveslippedandnolongerbeprovidingadequatetamponade.
5. IfpatientistransferredfromanotherhospitalthenrepeatCXRshouldbeperformedonarrivaltoconfirmthepositionofthetube(Fig.4).Theoesophagealballoonshouldalsobeaspiratedtoensureitisempty.
Fig.1–ClinySengstakenBlakemoreTube(SBT)
Fig.4 -CorrectpositionofSBTonCXR(picture–radiopedia)
Fig.3-HowtosecuretheSBTatthemouth
Fig.2–IllustrationofSBTinpositionwithgastricballooninflated.
Gastricballoon
Oesophagealballoon
Gastricport
Oesophagealport
Aspirationports:Gastric(blue)andoesophageal
(white)
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