W16 Esophageal Balloon Tamponade
Before Procedure
Procedure
• Test the integrity of the gastric and esophageal balloons of the Minnesota tube by inflating them fully. Deflate the balloons, making sure all the air is out.
• Insert tube transnasally, and advance it into the esophagus its full length. If the transnasal route cannot be used, transoral insertion is also acceptable.
• Put 30 to 50 mL of air through the gastric port, clamp it, and check for correct placement. The partially inflated gastric balloon must be clearly seen below the diaphragm on a chest x-ray. Do not overinflate the gastric balloon during this step, as accidental full balloon inflation in the esophagus would likely lead to esophageal rupture.
• Pull the tube back slowly until meeting with resistance. Traction can then be applied in a number of ways: with an overhead frame-pulley system—such as the one used for skeletal traction—or by securely taping the tube to the nose. More creatively, the patient can be fit with a football helmet or a catcher’s mask, which are then used to stabilize the tube. The frame-pulley system has the advantage that the degree of traction can be accurately measured. A 1-kg weight is enough (a 1-L bag of a crystalloid solution can be conveniently used).
• Separately connect the gastric and esophageal ports to suction, and monitor the output. If blood continues to come out of the esophageal port, inflate the esophageal balloon to 25 to 35 mm Hg (this is best done by attaching a three-way stopcock to the inflation port, with one of the limbs connected to a transducer for continuous pressure monitoring).
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