Complications of Sengstaken-Blakemore tube insertion

By Alex Yartsev - 13/07/2015

This features in Question 30 from the second paper of 2015, Question 30 from the first paper of 2013, and Question 18.3 from the first paper of 2008. The questions usually ask the candidate to come up with a list of complications, and then to give brief suggestions as to how one might avoid them.

Complications of Sengstaken-Blakemore Tube Insertion
Complication	Preventative measure
Aspiration	Use only in intubated patients Sit the patient up to 45° Aspirate all gastric content before inflating the gastric balloon
Oesophageal rupture	Ensure both balloons completely deflated prior to insertion Avoid inflation of oesophageal balloon Ensure gastric balloon is correctly positioned during inflation
Gastric balloon migration; upper airway obstruction	Only use in intubated patients An older paper recommends the tube be fixed in position to the face mask of a standard football helmet
Oesophageal necrosis	Dont inflate the oesophageal balloon Avoid using this device for longer than 24-36 hrs Avoid using traction for prolonged periods Deflate the balloon regularly to check for rebleeding Monitor the gastric/oesophageal pressure carefully - keep it under 15mmHg

References

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.

Puyana, Juan Carlos. "Gastroesophageal Balloon Tamponade for Acute Variceal Hemorrhage" - from Irwin and Rippe's Intensive Care Medicine, 7th Edition

Seet, E., et al. "The Sengstaken-Blakemore tube: uses and abuses." Singapore medical journal 49.8 (2008): e195-7.

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