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)