Placement of a Blakemore Tube for Bleeding Varices

How to place a Sengstaken-Blakemore tube for massive upper GI bleeding from esophageal or gastric varices. Presented by Jess Mason, MD.

Ross C. -

amazing resource !

Matthew L. W. -

will defintely use this real time if ever have to do this...

CK -

Anyone know how many cc's on average for esophageal inflation? Just looking for ballpark on what to start.

Jess Mason -

Just to reiterate (and I see that you know this) do not inflate the esophagus balloon based on volume — only by pressure. It’s very easy to accidentally cause esophageal injury or rupture this way. For a ballpark, it’s surprisingly little air and is typically around 30 cc in my experience. But only use this number as a frame of reference and again, do not ever inflate the esophagus balloon based on volume.

Alec C. -

Did one of these for the first time on a real patient a few days ago. Took 4 pumps with the manometer trigger to get to ~35mmHg, similar to the video. At first the trigger wasn't doing anything, and we thought there was an air leak in the tubing. After some time we realized our manometer had a switch on it that was a release valve, set to open, so the manometer itself was releasing all the air we tried to pump in. Once we flipped the valve switch it started working. Make sure you know your device!

Alex L. -

What is the purpose of pulling the NG tube to the E mark? Is it just to get it out of the esophagus but continue suctioning while you inflate the esophageal balloon?

Would the same thing be accomplished if you completely removed the NG tube and then reinserted it?

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