Identify the item of equipment depicted in the image below.
(Gastro-oesophageal balloon tamponade device or Minnesota tube acceptable)
OR Any other acceptable technique.
E.g.: inflate gastric balloon with no more than 80 ml of air (or contrast) and confirm position on AXR or via gastroscope then inflate gastric balloon slowly to a volume of 250-300 ml (up to 450 for Minnesota tube) and clamp balloon inlet.
Pressure necrosis of gastric mucosa:
Upper airway obstruction secondary to balloon migration:
The college had omitted their own image. The picture above was stolen from www.medipicz.com.
The college say "Minnesota tube acceptable". But... is it really? Is there any difference between them?
Well. Yes there is.
The Minnesota tube is actually a modified version of the original Sengstaken-Blakemore device. The modification is an oesophageal suction port, which prevents the pooling of filth in the upper oesophagus. You can tell them apart instantly - the Minnesota tube has four ports at the end, whereas the SB tube has only three. One can also have a Linton-Nachlas tube, which only has two ports, and a single 600ml gastric balloon.
Thus, the device in my picture is properly called a Sengstaken-Blakemore tube, and to call it a Minnesota tube would just be plain wrong.
The balloon labelled "A" is the gastric ballon. It inflates to a considerable diameter, and so it is fairly important that you do not inflate it in the oesophagus. Hence the anxiety regarding its position.
One can do this in a number of ways. The college would have accepted "any other acceptable technique".
The complications and preventative measures are best presented in the form of a table:
|Gastric balloon migration; upper airway obstruction||
What are the indications for the use of the SB tube? There really is only one. Control of variceal bleeding. However, others have used it to tamponade uterine bleeding, which can possibly extend to rectal bleeding via protocol creep.
What are the contraindications for the use of the SB tube?
Nepean ICU - A McLean, V McCartan - Insertion, care and removal of the Sengstaken Blakemore or Linton tube (2005)
Bennett, Hugh D., Lester Baker, and Lyle A. Baker. "Complications in the use of esophageal compression balloons (Sengstaken tube)." AMA archives of internal medicine 90.2 (1952): 196-200.
Bauer, JOEL J., I. S. A. D. O. R. E. Kreel, and ALLAN E. Kark. "The use of the Sengstaken-Blakemore tube for immediate control of bleeding esophageal varices." Annals of surgery 179.3 (1974): 273.
Seror, J., C. Allouche, and S. Elhaik. "Use of Sengstaken–Blakemore tube in massive postpartum hemorrhage: a series of 17 cases." Acta Obstetricia et Gynecologica Scandinavica 84.7 (2005): 660-664.