INDICATIONMassive, uncontrolled upper-GI hemorrhage from esophageal/gastric varices when endoscopy is unavailable, delayed, or failed — a temporizing bridge to endoscopy or TIPS, not definitive therapy.
Sengstaken-Blakemore tube (3-lumen, dual balloon) — the Minnesota tube is not stocked at this site
Separate NG/OG tube — for proximal (above-balloon) aspiration
Two 60 mL syringes (gastric port + esophageal port)
3-way stopcocks ×2; luer-lock caps
Insufflation manometer
Basin of water — leak-test both balloons before insertion
Water-soluble lubricant; marking pen
Roller gauze / umbilical tape + 1 L IV fluid bag — traction weight
IV pole or overhead pulley — traction line
Suction canisters ×2 (gastric port + proximal NG/OG)
AIRWAY — BEFORE ANYTHING ELSE
Full RSI / intubation setup — mandatory; do not insert in a non-intubated patient
AT THE BEDSIDE, ALWAYS
Scissors taped within reach for the entire dwell time
FIG 1 · TUBE IN PLACE — BALLOONS & TRACTION
STEPS
Airway first: intubate. Do not attempt this procedure in a non-intubated patient — aspiration risk is extreme.
Leak-test both balloons underwater before insertion; lubricate the tube generously.
Insert orally to the 50 cm mark. Never force advancement.
Confirm gastric position: inject air via the gastric port while auscultating the epigastrium; inflate gastric balloon with an initial 50 mL air. Get a CXR to confirm position before full inflation.
Complete gastric inflation in 50–100 mL steps to 250–300 mL — the Sengstaken-Blakemore figure, which is the tube stocked here. A Minnesota tube takes 450–500 mL; do not carry that number across. STOP if pressure rises >15 mmHg above the pre-insertion reading — suspect esophageal placement and deflate immediately.
Clamp/cap the gastric port; withdraw gently until resistance is felt — balloon seated against the GE junction.
Apply traction: tie roller gauze/tape to the tube over a pulley or IV pole; hang a 1 L IV fluid bag (≈1 kg) for constant inline traction. Mark and record tube depth at the lips.
Start continuous suction on the gastric port. Place the separate NG/OG tube for proximal aspiration above the gastric balloon.
Bleeding continues despite an adequately inflated, traction-seated gastric balloon → inflate the esophageal balloon (SB tube) to 30 mmHg via manometer; titrate up in 5 mmHg steps, never exceeding 45 mmHg.
Deflate the esophageal balloon intermittently every 6–8 h; total dwell ≤24 h. This buys time only — call GI/surgery for definitive therapy (endoscopy/TIPS) immediately, not after.
Scissors at the bedside, always. Sudden airway obstruction or respiratory distress = cut all lumens and remove the tube immediately.