Sengstaken tube

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Most commonly used tubes are Sengstaken-Blakemore tube and Minnesota tube. Latter has a fourth lumen which allows intermittent suctioning above the oesophageal balloon. This reduces, but does not eliminate the risk of aspiration pneumonia. If Sengstaken tube is used a Salem sump drain should be inserted through the mouth to a position just above the oesophageal balloon.

Other tubes include Linton and Nachlas tubes

• check lumens for patency and check balloons for leaks
• lubricate tube generously with lignocaine gel
• insert through nose or mouth. Former not recommended in patients with coagulopathy
• pass into stomach and confirm position by auscultation
• inflate gastric balloon with no more than 80 ml of air (or contrast) and confirm position radiographically
• inflate gastric balloon slowly to a volume of 250-300 ml (up to 450 for Minnesota tube) and clamp balloon inlet
• apply traction to tube
• if bleeding persists inflate oesophageal balloon to 45 mmHg (use bedside manometer). Monitor and maintain this pressure
• intermittent suction to gastric and oesophageal lumens (Minnesota) and continuous suction to sump drain
• tautness and inflation of balloons should be checked periodically by experienced personnel
• tube should be left in place for at least 24 h (?)
• gastric balloon tamponade can be maintained continuously for 48 h but oesophageal balloon must be deflated for 30 mins every 8 h
• monitor position of tube radiographically at least every 24h
• a pair of scissors should be at the bedside in case balloon ports need to be cut for rapid decompression: balloon may migrate and cause acute upper airway obstruction

When haemorrhage is controlled deflate oesophageal balloon first. Leave gastric balloon inflated for further 24-48 h (controversial). If there is no evidence of bleeding deflate gastric balloon but leave tube in place for a further 24 h.

• aspiration pneumonia most common
• acute laryngeal obstruction most severe complication
• oesophageal perforation
• mucosal ulceration

Puyana JC. Management of acute esophageal variceal haemorrhage with gastro-esophgeal balloon tamponade. In Rippe JM et al (eds). Procedures and techniques in intensive care medicine. 1995

© Charles Gomersall December 1999

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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