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What Is Sengstaken-Blakemore Tube Placement?

Reviewed on 7/29/2020

What is a Sengstaken-Blakemore tube?

Sengstaken-Blakemore tube
A Sengstaken-Blakemore tube involves the insertion of an SB tube either through the nose or mouth to slow or stop bleeding from the esophagus or stomach caused due to varices.

A Sengstaken-Blakemore tube (SB) tube is a red tube that prevents or slows bleeding from the esophagus or stomach caused due to gastric or esophageal varices. Gastric or esophageal varices are enlarged veins in the esophagus or stomach.

The three major parts of an SB tube are:

  1. Gastric balloon port, which inflates a small balloon in the stomach
  2. Esophageal balloon port, which inflates a small balloon in the esophagus
  3. Gastric suction port, which removes fluid and air out of the stomach

A variation of the SB tube known as a Minnesota tube has the addition of an esophageal suction port to help prevent additional suction of fluid (aspiration) of esophageal content.

What is Sengstaken-Blakemore tube placement?

Sengstaken-Blakemore (SB) tube placement involves the insertion of an SB tube either through the nose or mouth to slow or stop bleeding from the esophagus or stomach caused due to varices.  

Following are the indications for SB tube placement:

  • Acute bleeding from the varices that fail to respond to medical therapy
  • Acute life-threatening bleeding from esophageal or stomach varices when endoscopic hemostasis and vasoconstrictor therapy are unavailable

When should be the placement of a Sengstaken-Blakemore tube avoided?

Sengstaken-Blakemore (SB) tube placement should be avoided if you have

  • Undergone a recent surgery of the esophageal and stomach muscles.
  • Esophageal strictures (narrowing of the esophagus).

How is Sengstaken-Blakemore placement done?

The physician inserts the Sengstaken–Blakemore (SB) tube either through the nose or mouth. The oral route is the preferred route. Before inserting the tube, you would be intubated and mechanically ventilated to control your breathing. The physician administers an intravenous (IV) fluid to maintain your blood circulation and volume. 

The physician tests for any leaks in the balloon by inflating the balloon and submerging it underwater. The physician then deflates the balloon and coats it on a tube with a lubricating jelly. 

Next, the physician inserts the SB tube to at least a 50 cm mark. To ensure the tube reaches your stomach, they inflate the gastric balloon with a small amount of air. Once the inflated balloon is correctly placed, the physician inflates it with additional air to reach the desired pressure.

Once the SB tube is inserted, the physician connects it to weight for traction. They gently pull the tube back until the resistance is felt. They apply suction to the SB aspiration port to remove any blood clots. If bleeding persists from gastric aspiration, after inflation of the balloons, they increase the weight on the tube.

Once the bleeding is controlled, the physician reduces the pressure in the esophageal balloon. 

Once the bleeding has stopped, the physician performs the following steps to remove the SB tube:

  • Deflate the esophageal balloon
  • Take out weight from the SB tube
  • Deflate the gastric balloon
  • Take out the SB tube

Are there potential complications to using the Sengstaken-Blakemore tube?

You can expect a few risks from using a Sengstaken-Blakemore (SB) tube. If placed improperly, the SB tube can affect your ability to breathe. Complications that may arise due to improperly placed tube or ruptured balloons include:

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References
References:

https://emedicine.medscape.com/article/81020-technique#c3
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