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32 Comments on "Blakemore Tube Placement for Massive Upper GI Hemorrhage"

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Brian Geyer
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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?

Aladdin
Guest

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.

Matt
Guest

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 through the SGA. I don’t think this would work with an intubating LMA but if a patient comes in with a combitube or king LT it works really well and I have had no difficulties with this technique. Thoughts?

Mary
Guest

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.

Mike
Guest

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?

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Matt
Guest
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 esophageal suction seems essential. Why not tape a salem sump to the Blakemore with a single piece of cloth tape 2cm proximal to the esophageal balloon to provide continuous esophageal suctioning? That way when you insert the Blakemore you’re also inserting a drain for the esophagus that is exactly where you want it to be and isn’t going anywhere. Presumably the pt I’m going to consider placing a Blakemore tube in is already intubated, which means that I may have already placed an orogastric tube anyways. In which case, should I remove that OGT before placing the Blakemore tube? Also… Read more »
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[…] tube for massive variceal haemorrhage. Watch Scott Weingart’s video on how to do it here: http://emcrit.org/procedures/blakemore-tube-placement with notes by Chris Nickson […]

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[…] These devices also use a balloon tamponade technique for short term haemostasis. Have a look at Scott Weingarts How-To of SB Tubes:  […]

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[…] Handy how-to from Dr. Weingart on his EMCrit blog (It’s a bit complicated, so the video is worth a watch): […]

K. Stevens
Guest

the link to your PDF “Cheat Sheet” regarding the blakemore tube placement is missing (?)

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[…] practice. An excellent tutorial on the insertion of a Sengstaken-Blakemore tube can be found here on Dr. Scott Weingart’s always-brilliant EmCrit blog4: Antibiotic prophylaxis in patients with […]

mohammed
Guest

we did this a few times at northshore, checked position in stomach with ultrasound instead of cxr, much faster.

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[…] -Blakemore may be your ED “hail Mary”. Intubate to avoid aspiration. Get a stat CXR before fully inflating the gastric balloon. Watch the procedure on EMCrit! […]

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[…] video and instructions […]

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[…] of blood loss, we didn’t have time to send the patient to surgery. So my attending placed a “Blakemore Tube” (Balloon Tamponade) to stop the bleeding. After 1-2 hours of bleeding, blood transfusions, and […]

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[…] Go to EMCrit Site for more details: http://emcrit.org/procedures/blakemore-tube-placement/ […]

Dean Burns
Guest

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

Natalie
Guest

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

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[…] Weingart over at EMCrit has a fantastic page with some videos demonstrating its use, so check those out here […]

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