Cite this post as:
Scott Weingart, MD FCCM. Blakemore Tube Placement for Massive Upper GI Hemorrhage. EMCrit Blog. Published on October 13, 2013. Accessed on January 20th 2025. Available at [https://emcrit.org/emcrit/blakemore-tube-placement/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: October 13, 2013
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
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Hey Scott,
Thanks for the great post. We had a run of bad UGIB at my institution of which I was able to participate in the placement of two of these tubes. We placed the tubes through the nose (just like an NG) in both intubated patients with good effect and no immediate complications. Any thoughts on this?
wouldn’t be my 1st choice. I’d rather place a bougie blind with intubating LMA, though usually the LMA is enough to shield the glottis and allow fiberoptic intubation.
Thanks for the quick reply. As busy as I am sure you are, this is a huge deal and your blog fans really appreciate it. I ha e to appologize for being unclear. By “tube”, I meant Blakemore tube. The patient was already intubated. Any issues you are aware of with nasal Blakemores? On a personal note, I saw you lecture a few years back at ACEP about Adame, et. al 2006 AEM Jan 13(1):114-6. Norberto Adame is a mentor of mine and he dedicated that technique to his friend with the nickname “Mac” who was a flight medic who… Read more »
Ahhh, gotcha. Yes, you can definitely go nasal. IN the ICU, we prefer to keep the nose free of big tubes (just tiny little feeding tubes). But in this case there are bigger issues and if you can get it in the nose, but not the mouth, go for it.
Thanks for that personal note.
I’m trying to push for the use of Blackmore tubes in cases of massive GI bleed where endoscopy couldn’t be done in a timely manner. I was wondering if there is any evidence that it works! That will make it easier for me to advocate it’s use.
Scott Wondering if you have ever left a SGA ie combitube or king LT in place and then do a VL intubation? I have done a few with a glidescope where you visualize the balloon – place pressure against the balloon to keep air pushed down into the esophageal portion of the balloon while a assistant ie my attending withdraws 10 cc of air at a time. Eventually the cords come into view and are easily intubated with an 8.0 ett and a glidescope stylet. The beauty of this technique is that my RT is ventilating and oxygenating the patient… Read more »
My friend Jim DuCanto is the master of the maneuver you describe and he has done a bunch. He has some great videos of the technique. For me, I’m pulling it, getting my ideal shot at video. If I fail, I immediately place an intubating LMA that will allow me continuous oxygenation/ventilation while intubating through it.
Thank you for this excellent video and inspiring me to practice Blakemore placement!
Please forgive me if this is a dumb question… When you measure pressures while inflating the esophageal balloon, why do you attach a 2nd 3-way stopcock with an iv extension set? Why not just attach the sphygmomanometer tubing to the free port of the first stopcock? (It looks like that is what Dr. Taddei does in her video.)
Thanks again for another amazing podcast and video.
her christmas tree adapter is female-tipped, mine is male. Mine is more versatile. : )
The tubes that our hospital carries have a gastric lavage port that looks like the one in your video, but the other 3 ports are much smaller, too small to fit a Christmas tree adapter (link to a pic below). I spoke to the GI guy who uses them fairly often, and he says he puts in some air, takes the tip off of the sphygmomanometer and attaches it directly to the end of the port to see what the pressure is, then adjusts the amount of air from there. Seems really clumsy – any better ideas?
Thanks for the wonderful work as always. I can’t begin to say how much I’ve learned from your site. A few questions though: Is the point of the gastric ballon to prevent the tube from slipping out, or are you trying to directly tamponade any culprit ulcer, gastric varix/gastropathy bleeder, Dieulafoy lesion, or the like? If the pt is bleeding from esophageal varices when you inflate the gastric balloon I’d imagine that all that blood that was making them hypotensive would be coming up rather than down! In which case if you’re placing a Blakemore for esophageal varices then that… Read more »
Matt, the gastric balloon is directly cutting off the blood supply of most of the esophageal varices–it is directly treating them. taping the salem sump makes insertion harder (it already kind of sucks). If you already have an OGT in, it is a toss up whether you should take it out first. Sometimes it stents the esophageal sphincter allowing easier placement, but when you need to yank it (and you will before you inflate the balloon) it may yank out the blakemore.
the link to your PDF “Cheat Sheet” regarding the blakemore tube placement is missing (?)
working fine on my end
we did this a few times at northshore, checked position in stomach with ultrasound instead of cxr, much faster.
how did you do the check with ultrasound?
Hi Scott
I’m slightly unclear on the identity of the tubing used to connect the sphygmomanometer to the luer lock adapter of the 3 way tap. I’ve tried various extension sets from our department but the ends don’t connect. What is the commercial name of this tubing?
The end of the sphygmomanometer is a male end, so it’d need to be a female end to go over it. Does this make sense?
Great video – very instructive but I’m uncertain on this one point.
Best wishes
Dean
here you go:
https://www.cookmedical.com/products/di_llal_webds/
get the male luer
Oh no….not the Christmas tree adapter, I have those. The tubing that connects the sphygmomanometer to the 3 way tap at 8:30 on the emcrit video. Is it a saline lock?
Do you have a brand name for that?
If not, don’t worry about it. We ought to invest in some Posey cuff manometers for our ED and I’ve noticed the other video demonstrates the use of the Posey manometer beautifully.
yep, just a saline lock. think i said that in the video. Yep, I recommended the cuff-o-lator to Jess when she told me their bp manometers didn’t fit
Scott,
I am curious if this method of securing the Blakemore has been published to use as evidence base practice? The video and attached cheat sheet are great!!!
Thank You
for clarification the “slip knots” are actually girth hitches
Hey Scott, thanks for this content. I wanted your input on a question that came up during our last placement. -The way this procedure is typically taught involves additional steps to allow for assessment of bleeding the in esophagus (measuring, marking, placing and suctioning the OGT after the gastric balloon has been inflated). -This procedure is low frequency and typically done during busy resuscitations, and the additional steps required for the above can feel a bit cumbersome -I have started to feel that removing those steps and moving to empiric inflation of the esophageal balloon is not unreasonable (assuming the… Read more »
a lot of problems occur with the esophageal balloon (rupture even within desired pressures, ischemia, etc.) so if you can avoid it, best to avoid it. The pain in the butt of dealing with manometers seems greater than just dropping an OGT