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Comment on this procedure
* Inserted by a Gastroenterologist or a medical officer who is skilled at this procedure.
* The patient will have an endotracheal tube in-situ (with rare exceptions), prior to insertion of a Sengstaken-Blakemore tube.
* The patient will be nursed in ICU by an ICU Registered Nurse or a Registered Nurse who is under the supervision of an ICU RN while balloons are inflated.
* Patients safety will be maintained during insertion, whilst this tube is in-situ and during extubation.
* Universal precautions will be adhered to during insertion whilst this tube is in-situ and during extubation.
OUTCOMES:
* Bleeding from oesophageal varices will be arrested while tube is in-situ and following the deflation of balloons.
* The tube will be placed and maintained in the correct position as evidenced by:
- Aspiration and pH testing OR
- Injecting air and auscultating over stomach AND
- X-ray confirming that the part of the tube where the oesophageal and gastric balloons meet is at the level of the xiphoid process.
* Accurate records will be kept of amount and nature of drainage from tube or from mouth.
* Intensivist will be notified in the event of:-
- Evidence of markedly increased haemorrhage
- Evidence of shock
- Evidence of respiratory embarrassment should the tube migrate superiorly
* Correct traction weight and balloon pressures will be maintained as prescribed by Gastroenterologist or appropriately skilled medical officer.
* The patients nose and mouth will be kept clean and free of pressure areas.
EQUIPMENT: Sterile Sengstaken-Blakemore tube with instructions
Pair of scissors
50ml syringe
2 x rubber tipped artery forceps
Water soluble lubricant
3 metres of white linen tape
Adhesive tape
Pressure gauge
Weight for traction
Pulley
Drainage bag
Gloves
Goggles
Plastic aprons
PROCEDURE:
* As per MALLINCKRODT AUSTRALIA Pty Ltd "Instructions for use of Sengstaken-Blakemore Tube" for details re insertion.
ALERTS:
* Balloon pressures should never exceed 45mmHg.
* Fully deflate both balloons prior to extubation.
* Clamp the tube before extubation to prevent liquid escaping from distal end and being aspirated into lungs.
* Traction (if ordered) must be maintained as constant at all times.
* Scissors are kept near patient at all times in case balloons migrate superiorly and cause respiratory obstruction in non intubated patients. The whole tube can be cut and removed, remembering to grasp the tube between the patient and scissors.
* The used tube should be washed and dried, once removed, and placed in a paper bag, along with "instructions for use" and remain with the patient until discharge. The tube may need to be reinserted if bleeding reoccurs.
R : 10.2
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It was originally posted on 6/5/98; 2:28:03 PM.
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