NOT YET REVIEWED BY A CLINICIAN. Written for this site and cited, but nobody has read it line by line. Check it against your own practice before you use it.
STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME
AIRWAY FIRST — THEN THE TUBE
Intubate first.
Two tested suctions, rigid tips, both at the head of the bed. Bed up 45°.
Leak-test both balloons underwater before insertion; lubricate the tube generously.
Scissors taped within reach for the entire dwell time.
Sudden airway obstruction or respiratory distress at any point = cut all lumens and remove the tube immediately.
INSERT AND SEAT THE GASTRIC BALLOON
Insert to 50 cm at the lips. Confirm past the GE junction before full inflation.
Confirm gastric position: inject air down the gastric port while auscultating the epigastrium; inflate the gastric balloon with an initial 50 mL of air, then a chest film before full inflation.
Gastric balloon: 50 mL, then 50–100 mL steps to 250–300 mL. Stop inflating if the patient has pain. ◆ GASTRIC BALLOON INFLATED — 250–300 mL
Those are Sengstaken-Blakemore volumes — the tube stocked here; a Minnesota tube takes 450–500 mL. Stop if the pressure rises more than 15 mmHg above the pre-insertion reading: suspect esophageal placement and deflate at once.
Clamp the gastric port; withdraw gently until resistance — the balloon is seated against the GE junction.
Traction ≈1 kg — a 1 L fluid bag over a pulley. Mark the tube at the lips. ◆ TRACTION ON — ≈1 kg
Continuous suction on the gastric port; the separate NG/OG tube sits above the gastric balloon for proximal aspiration.
STILL BLEEDING — THE ESOPHAGEAL BALLOON
Esophageal balloon only if still bleeding: 30 mmHg, 5 mmHg steps, max 45. Deflate q6–8 h. ◆ ESOPHAGEAL BALLOON INFLATED — ≤45 mmHg
Balloon tamponade: a bridge when endoscopy is unavailable or failed. Max dwell 24 h.
Call GI — variceal within 12 h, non-variceal within 24 h.
If no endoscopy on site, start the transfer call.
EQUIPMENT
Sengstaken-Blakemore tube
Two 60 mL syringes
Insufflation manometer
Roller gauze
Scissors taped within reach
FIGURE
A temporary measure until endoscopy or TIPS; never definitive treatment. Intubate first.