Balloon Tamponade: Purpose, Procedure, Benefits and Side Effects

Balloon tamponade is a medical procedure in which a balloon is inserted into the body and inflated to stop or control bleeding.

• Sengstaken-Blakemore tube: This is a type of balloon tamponade that involves the insertion of a tube into the oesophagus. The tube has two balloons, one in the oesophagus and one in the stomach. When inflated, these balloons compress the walls of the stomach and oesophagus to reduce bleeding from varices or other lesions in those areas.
• Linton-Nachlas tube: This type of balloon tamponade involves the insertion of a tube with two balloons, one in the oesophagus and one in the duodenum. When inflated, these balloons compress the walls of both organs to reduce bleeding from varices or other lesions in those areas.
• Fogarty catheter: This type of balloon tamponade involves the insertion of a catheter with an inflatable balloon at its tip into a vein or artery. When inflated, this balloon compresses blood vessels to reduce bleeding from ruptures or other lesions in that area.

• It helps to stop the bleeding quickly and effectively.
• It is an easy, safe and cost-effective procedure to control excessive bleeding.
• It can be used even in difficult to access areas such as the uterus or fallopian tubes.
• It is less invasive than other methods of controlling excessive bleeding, such as laparotomy or embolization.
• In certain cases, it can be used as a temporary measure until more definitive treatment can be performed.
• It may also help to reduce pain associated with the bleeding by putting pressure on the area where the bleeding is occurring.

• Balloon tamponade is done when other treatments have failed and the patient's bleeding is uncontrolled.
• It is a last-resort treatment for severe bleeding in the oesophagus, stomach or intestine.
• It involves temporarily inserting a balloon into the affected area to compress and close off the blood vessels that are causing the bleeding.
• Balloon tamponade can provide temporary relief while other treatments, such as surgery, are being considered.

Risk include:-

• Allergic Reaction: Balloon Tamponade can potentially cause an allergic reaction in some patients. This reaction may include hives, swollen face/lips/tongue, or difficulty breathing.
• Infection: There is a risk of infection at the insertion site where the balloon is inserted either directly or through improper handling or sterilisation techniques of equipment used during insertion and removal of the balloon.
• Injury to Blood Vessels: The balloon can cause trauma to surrounding blood vessels when it gets placed improperly and if there’s significant tugging on the catheter used to deploy it during its placement and removal.
• Cardiac Arrhythmias: Inflating and deflating the balloon too quickly or too often can lead to a heart rhythm abnormality during the medical procedure itself, known as cardiac arrhythmia.
• Loss Of Consciousness: The higher pressure caused by inflating the balloon tamponade device could reduce your blood pressure drastically resulting possible fainting spells during or after the device placement process

• In preparation for balloon tamponade, your doctor will likely advise you to fast before the procedure, as well as refrain from taking any blood-thinning medications such as aspirin or ibuprofen.
• Your doctor will also likely ask you to not eat or drink anything after midnight the night before the procedure.
• On the day of the procedure, you may be asked to wear loose-fitting clothing and remove any jewellery that could interfere with the procedure.
• It is important to follow all of your doctor’s instructions prior to and during the procedure.

• The balloon tamponade procedure involves inserting a catheter, with a small balloon attached, into the targeted area.
• When the balloon is inflated, it seals off and compresses the organ or structure that it has been inserted into.
• This pressure allows for the controlled release of any fluids that may be leaking from the affected area and helps to reduce any further damage that may occur due to leakage.
• Once the tamponade effect is achieved, usually with 1-3 balloons air forced through one end of each catheter tube, necessary steps are taken to ensure proper adjustment of positioning and stability of balloons so as to achieve desired effect according to the patient's diagnosis .

• Obtain informed consent from the patient for balloon tamponade.
• Ensure that all the necessary supplies and equipment are available.
• Educate the patient about the procedure, potential complications, and potential side effects so that they may make an informed decision about whether or not to proceed with it.
• Consider administering a sedative to relieve anxiety if needed.
• Have an assistant ready to help during the procedure if necessary.
• Position the patient in a supine or semi-Fowler’s position and remove any clothing or jewellery in the operative field if necessary for visualisation purposes; drape with sterile towels and cover exposed areas of skin with sterile drapes when applicable.
• Cleanse and sterilise skin in preparation for insertion of catheters/balloon devices outside of the operative field; inflate pads with air (optional).
• Obtain radiologic imaging studies required such as computed tomography (CT) scan/ultrasound images prior to insertion of balloon device(s).

• Wash your hands, put on gloves and prepare the supplies
• Have the patient lay in a supine position or sit in a semi-Fowler’s position with their legs brought up
• Place a sterile blanket under the patient's buttocks. This will help keep the area clean and dry during the procedure
• Gently insert an endoscope into the oesophagus and locate the bleeding site
• Introduce a balloon catheter through the endoscope and inflate it with air or saline until it is snug against the bleeding vessel
• Securely fasten the catheter so that its position is unchanged as you withdraw it from the oesophagus
• Monitor for any signs of further bleeding, such as vomiting blood or coughing up bright red blood clots
• Record vital signs while monitoring for any changes in patient's condition during and after inflation of balloon
• Disconnect balloon after 20 minutes (the standard amount of time) and deflate before withdrawal
• Remove catheter through endoscope once done without over-extraction

• Insert a large-bore needle (14-16 gauge) through the skin of the abdomen and into the abdominal cavity.
• Using a balloon catheter, pass the balloon through the needle, invert it and pull it back out of the patient. The balloon should be filled with sterile electrolyte solution or saline
• Carefully inflate the balloon with sterile solution to lower pressure inside abdomen and occlude blood flow of spleen or abdominal vessels that cause haemorrhage
• Monitor patient's vital signs closely to ensure they remain stable throughout procedure
• Remove catheter and disposable equipment when finished and apply dressing to puncture site as necessary
• Document any interventions taken during procedure clearly in patient chart
• Follow-up with primary physician or specialist to discuss long-term care plan

The cost of Balloon Tamponade in India typically ranges between 35,000 to 70,000 Indian rupees.

The exact cost will depend on the severity of the condition and the hospital or doctor you consult.

• After having a balloon tamponade procedure, it’s best to stick to a modified version of the BRAT diet.
• The BRAT diet, which stands for Bananas, Rice, Applesauce and Toast, is designed to be easy on digestive systems that have been compromised.
• Some other foods that may help settle the stomach include oatmeal, yoghurt, dry crackers, cooked vegetables (like mashed potatoes or squash), lean protein sources like boiled chicken or low-fat fish. Additionally you can drink clear liquids such as water and apple juice.
• It’s important to make sure that the food you are eating is not too spicy or acidic as those can cause stomach upset.
• If symptoms persist after 48 hours it is recommended to see your doctor for further assessment and guidance.

• The safety of balloon tamponade depends on the procedure being done and the condition of the patient, as well as other factors.
• In general, it is considered a safe, minimally invasive procedure when done by an experienced healthcare provider who follows accepted safety protocols.
• Serious complications related to balloon tamponade are rare but can include infection, bleeding, organ perforation or damage to internal organs, and rarely death.
• Generally speaking, Balloon Tamponade is a relatively safe procedure when performed properly and with proper patient consent and preparation.

• Most patients report that the balloon tamponade procedure is not painful.
• The procedure involves the insertion of a balloon into the oesophagus, and then inflating it with saline or air to stop bleeding from abnormal vessels in the oesophagus.
• This is usually done as an emergency treatment for uncontrolled bleeding, so patients are usually sedated for the procedure to ensure comfort.
• Some patients may experience discomfort during and after the procedure due to pressure from the balloon and soreness of the throat.
• However, this pain is usually mild and easily managed with medication or bed rest.

Generally speaking, the recovery period will typically take anywhere from 2-3 weeks.

• The most common side effects of balloon tamponade are nausea, vomiting, and abdominal discomfort.
• Other side effects can include abdominal cramping, dizziness, headache, back pain, chest pain, and fatigue.
• More serious side effects may include bleeding from the rectum or stomach.

• Monitor vital signs closely and watch for signs of shock.
• Administer antibiotics to prevent infection.
• Encourage adequate hydration and nutrition in order to speed the healing process.
• Apply ice packs to the area as needed for pain relief.
• Avoid activities that could cause strain or further trauma to the area, such as lifting heavy objects or engaging in strenuous exercise.
• Follow up with a doctor as recommended, typically within one week after the procedure, for evaluation and treatment of any complications that may arise from the procedure or from underlying conditions that may have contributed to it.

The balloon tamponade is a safe and successful procedure for the management of bleeding from certain types of ulcers, specifically those caused by esophageal varices and gastric/esophageal tumours. It is relatively simple to perform, with low morbidity and mortality rates, making it one of the more preferred treatments for these conditions.