The client with bleeding esophageal varices has a Blakemore tube in place
16 Accesses AbstractThe Sengstaken-Blakemore tube may be used in life-threatening esophageal variceal bleed refractory to endoscopy and medical therapy. Keywords
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Rights and permissionsCopyright information© 2022 Springer Nature Switzerland AG About this chapterCite this chapterNguyen, T.T., Burmon, C., Nguyen, S. (2022). Sengstaken-Blakemore Tube. In: Ganti, L. (eds) Atlas of Emergency Medicine Procedures. Springer, Cham. https://doi.org/10.1007/978-3-030-85047-0_84 Download citation
BackgroundBalloon tamponade of bleeding esophageal varices was described as early as the 1930s. A double-balloon tamponade system was developed by Sengstaken and Blakemore in 1950 and has undergone relatively few changes up to the current day. [1, 2, 3, 4] The three major components of a Sengstaken-Blakemore tube are as follows (see the image below):
The addition of an esophageal suction port to help prevent aspiration of esophageal contents resulted in what is called the Minnesota tube. Another nasogastric (NG) device with a single gastric balloon is most effective at terminating bleeding from gastric varices and is known as the Linton-Nachlas tube (see the image below). [5] Linton-Nachlas tube. Image courtesy of Richard Treger, MD.The advent of endoscopy has reduced the use of balloon tamponade, but the use of such devices can still be temporizing or lifesaving, despite their potential for serious complications. [6, 7, 8, 9, 10] IndicationsIndications for placement of a Sengstaken-Blakemore tube include the following:
Chen et al described a case in which a Sengstaken-Blakemore tube was successfully used for nonvariceal distal esophageal bleeding (from severe ulcerative esophagitis) after conventional medical and endoscopic therapy had failed. [16] Use of a Sengstaken-Blakemore tube to tamponade oropharyngeal hemorrhage during exploration of a carotid injury was reported by Bensley et al. [17] Evans et al described a case where placement of a Sengstaken-Blakemore tube was employed as a rescue treatment for hemorrhagic shock secondary to laparoscopic adjustable gastric band erosion. [18] A case series by Kim et al illustrated the use of s Sengstaken-Blakemore tube as a hemostatic tool in patients with life-threatening intractable oronasal bleeding secondary to facial trauma. [19] ContraindicationsContraindications for placement of a Sengstaken-Blakemore tube include the following:
OutcomesIn a study aimed at determining the effect of controlling variceal hemorrhage with a balloon tamponade device (eg, Minnesota or Sengstaken-Blakemore tube) on patient outcomes, Nadler et al assessed survival to discharge, survival to 1 year, and development of complications. [20] Approximately 59% of patients survived to discharge, and 41% were alive after 1 year. One complication, esophageal perforation, was noted; it was managed conservatively.
Author Richard Treger, MD Assistant Clinical Professor of Medicine, Division of Nephrology, Greater Los Angeles VA Healthcare System, University of California, Los Angeles, David Geffen School of Medicine Disclosure: Nothing to disclose. Coauthor(s) Thomas P Graham, MD, FACEP Clinical Professor of Medicine, Emergency Medicine, University of California at Los Angeles School of Medicine, UCLA Medical Center Thomas P Graham, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Wilderness Medical Society Disclosure: Nothing to disclose. Stanley K Dea, MD Chief of Endoscopy, Acting Chief of Gastroenterology, Consulting Gastroenterologist Olive View-University of California at Los Angeles Medical Center; Director of Enteral Feeding, West Los Angeles Veterans Affairs Medical Center; Director of Endoscopic Training, University of California at Los Angeles Affiliated Training Program in Gastroenterology Stanley K Dea, MD is a member of the following medical societies: American Society for Gastrointestinal Endoscopy, Southern California Society of Gastroenterology Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Chief Editor Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, FFST(Ed), MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, FFST(Ed), MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Fellow of the Faculty of Surgical Trainers (RCSEd), Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England, Society for Surgery of the Alimentary Tract Disclosure: Nothing to disclose. Additional Contributors Acknowledgements Thanks to CR Bard, Inc, for their assistance. The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the assistance of Lars J Grimm, MD, MHS, with the literature review and referencing for this article. The Chief Editor would like to acknowledge the assistance of Dr Mohsina Subair, Postgraduate Resident, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India, in updating the review of this article. Which tube is used for bleeding esophageal varices?The Sengstaken-Blakemore (SB)tube is a red tube used to stop or slow bleeding from the esophagus and stomach. The bleeding is typically caused by gastric or esophageal varices, which are veins that have swollen from obstructed blood flow.
What is the Blakemore tube used for?A Sengstaken-Blakemore tube is a tube used in emergency medicine to stop bleeding in your stomach or esophagus. The technique used to place the tube is called balloon tamponade.
What is the most important nursing intervention for a patient with a SengstakenAirway protection remains the foremost focus. If the patient is requiring a Sengstaken-Blakemore tube placement, they have likely already been intubated for airway protection, but if not, endotracheal intubation should be performed prior to placement.
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