Sengstaken Blakemore Tube: Causes, Symptoms, Treatment and Cost

The Sengstaken Blakemore tube (also known as the Sengstaken-Blakemore tube or SBT) is a medical device used for controlling bleeding in the upper gastrointestinal tract.

It is a flexible tube with multiple lumens and has two balloons, one at the stomach end and one at the esophageal end. The balloons are inflated with air or fluid to stop bleeding in the stomach or oesophagus.

The device was first developed in 1949 by American surgeon Robert Sengstaken and British surgeon Arthur Blakemore.

• Double Lumen Tube: The Sengstaken Blakemore tube is a double lumen tube that is inserted into the oesophagus and stomach of patients with bleeding esophageal varices. It consists of two lumens, an outer lumen and an inner lumen, connected to a balloon-like device at the tip of the tube.
• Single Lumen Tube : The Sengstaken Blakemore tube is a single lumen tube used to treat bleeding esophageal varices. It consists of two balloons, an outer balloon and an inner balloon, connected by a single lumen tube. The outer balloon is inflated first with air or saline solution and then the inner balloon is inflated with a solution containing epinephrine.
• Cuffed Tube : A cuffed tube, also known as a Sengstaken-Blakemore tube, is a type of medical device used to control bleeding from esophageal varices. It is a long, thin, flexible tube with two inflatable balloons at either end. The smaller balloon is placed in the stomach and the larger one in the oesophagus.
• High Volume Low Pressure (HVLP) Tube: The High Volume Low Pressure (HVLP) tube is a medical device used to provide mechanical ventilation and to prevent gastric distention in patients who are unable to protect their airway. It consists of two tubes, one for suctioning the stomach contents and another for providing oxygen or other gases.

The benefits of using a Sengstaken Blakemore tube include:

• Reduced risk of bleeding: The pressure applied by the tube helps reduce the risk of bleeding from varices. This can prevent dangerous complications such as shock or death due to blood loss.
• Improved quality of life: By reducing symptoms associated with varices such as nausea, vomiting and abdominal pain, patients can experience an improved quality of life.
• Quick treatment: The procedure for inserting a Sengstaken Blakemore tube is relatively quick and simple compared to other treatments for esophageal varices such as surgery or endoscopic band ligation.
• Cost-effective: Compared to other treatments for esophageal varices, using a Sengstaken Blakemore tube is generally more cost-effective due to its simpler insertion procedure and shorter hospital stay required for treatment.

• The Sengstaken-Blakemore tube is used to treat bleeding in the upper gastrointestinal tract, typically caused by varices, which are dilated veins in the oesophagus or stomach.
• The patient's mouth or nose are used to introduce the tube, which is then advanced into the stomach.
• The balloon at the end of the tube is then inflated to apply pressure to the bleeding vessels, which helps to stop the bleeding.
• The tube is typically removed once the bleeding has stopped and the patient's condition has stabilised.
• It is also possible for the tube to be removed if the patient develops complications such as infection or if the bleeding cannot be controlled with the use of the tube

These risks include:

• Aspiration: When food or liquid enters the lungs as opposed to the stomach, aspiration occurs. Serious breathing problems and possibly death could result from this.
• Intestinal Perforation: The Sengstaken Blakemore tube may accidentally puncture a hole in the intestine while being inserted. This can cause infection and other complications.
• Damage to teeth or gums: Inserting this tube may cause damage to teeth or gums if not done properly by a trained professional.
• Bleeding: If not placed correctly, this device may cause additional bleeding from the oesophagus, stomach, or duodenum due to irritation of delicate tissue by the balloon portion of the device.
• Gastric Ulceration: The Sengstaken Blakemore tube may irritate existing gastric ulcers and increase their size due to prolonged contact with gastric acidity and pressure from balloon inflation.

• The preparation for a Sengstaken Blakemore tube procedure is extremely important.
• The patient should be well-hydrated and have a clean airway prior to the surgery.
• The patient should also have their vital signs monitored and have an intravenous line in place.
• The physician should also ensure that all necessary supplies are available, including the tube, syringe, lubricant, gloves, and suction equipment.
• Before starting the procedure, the doctor should spend some time walking the patient through it and answering any questions they may have.

• The procedure involves passing a long, thin tube down the patient's throat and into the stomach.
• Once in place, balloons at both ends of the tube are inflated with air or fluid, helping to stop blood flow into the oesophagus.
• In some cases, a sclerosant may also be injected through the tube to help close off any remaining varices.
• The procedure is usually done under general anaesthesia and can take up to an hour or more depending on how difficult it is to place the tube and inflate the balloons.

• Get the patient's informed permission by outlining the process.
• The patient should be positioned with their head slightly lifted in a semi-position. Fowler's
• Monitor vital signs, including oxygen saturation and blood pressure, throughout the procedure.
• Administer sedatives and analgesics as needed for patient comfort and relaxation.
• Prepare the Sengstaken Blakemore tube by connecting it to a high-pressure source of oxygen or air, and check for leaks in the system before insertion into the stomach.
• Assemble all necessary equipment and medications for insertion, including lubricant, stylet (if required), suction catheter, suture material, hemostats, clip applicator (if required), syringes for flushing of balloon with saline or air/oxygen mixture as well as medication administration via syringe through side port of tube if needed during procedure
• Use an antiseptic solution, such as povidone iodine or chlorhexidine gluconate, to clean the skin around the insertion site.
• Drape sterile field around insertion site
• Anesthetize skin around insertion site using 1% lidocaine with epinephrine

• Insert the Sengstaken Blakemore tube through the nose, mouth or a gastric fistula.
• Sutures and adhesive are used to secure the tube in place.
• Inflate the distal balloon with 10-20 mL of air to prevent reflux of gastric contents into the oesophagus.
• Connect a syringe to the proximal balloon port and inflate it with 30-50 mL of air, depending on patient size and condition.
• Connect a 3-way stopcock to the proximal end of the tube and attach an irrigation/suction device to it for continuous suctioning or lavage of gastric contents when necessary.
• Remove Sengstaken Blakemore tube after bleeding has been controlled or when no longer needed for therapeutic purposes

• Ensure that the patient is stable and that the balloon is inflated to the desired pressure.
• Securely fasten the tube to the patient’s nose and mouth with tape or sutures.
• Monitor vital signs, including blood pressure, pulse, oxygen saturation and respiration rate, for any changes.
• Monitor for any signs of bleeding or other complications related to the insertion of the tube or its use.
• Securely fasten a drainage bag to collect gastric contents from below the balloon inflation port of the tube and monitor its output regularly.
• Regularly check both balloons for leaks by inflating them with air and listening for a hissing sound or feeling for air escaping around their edges with your fingers while they are inflated in water in a basin or bowl of water at least twice daily (or more frequently if necessary).
• Monitor fluid intake and output as well as electrolyte levels carefully if intravenous fluids are administered through ports on the tube as part of treatment for shock or other conditions requiring volume resuscitation (elevated intracranial pressure can be treated this way).
• Administer medications as prescribed by your doctor through ports on the tube if necessary (antibiotics, antiemetics, etc.).
• Change dressings over ports on the tube when soiled/wet/damp from drainage/secretions/exudate at least once daily (or more frequently if necessary).
• Assess skin integrity around sites where tube is secured to ensure it does not cause skin breakdown due to friction or pressure points; repositioning may be necessary if skin breakdown occurs despite preventive measures taken such as padding areas where tubing contacts skin with gauze sponges or foam dressing pads under tape/sutures securing tubing in place).

The cost of a Sengstaken Blakemore tube in India can vary depending on the brand and supplier, but typically ranges from around Rs. 2000 to Rs. 6000.

• After having a Sengstaken Blakemore tube inserted, it is important to follow your doctor's instructions for eating.
• Depending on your condition and the type of procedure you had, you may be instructed to start with a clear liquid diet such as water, broth, or apple juice.
• You may then be allowed to slowly add in soft foods such as mashed potatoes, oatmeal, yoghurt, and applesauce.
• Avoiding high-fibre foods such as nuts and seeds is recommended until your doctor gives you the go-ahead.

• Yes it is safe when it is performed by experience surgeon
• While it can be effective in controlling bleeding, it can also be associated with risks and complications.
• Complications may include infection, damage to the esophageal wall, perforation of the oesophagus or stomach, aspiration of gastric *contents into the lungs, and even death.

• No, the Sengstaken Blakemore tube is not painful.
• The patient's nose or mouth is used to introduce the tube, which is then passed through their stomach and duodenum*.
• The insertion process may cause some discomfort, but it does not usually cause pain.

Recovery from a Sengstaken Blakemore tube typically takes several days to several weeks depending on the patient's overall health and the severity of their condition.

Generally, patients who have had a Sengstaken Blakemore tube inserted for a short period of time and who are in good health may recover within days, while those with more serious conditions or who have had the tube inserted for longer periods of time may take weeks to fully recover.

The most common side effects of a Sengstaken Blakemore tube include:

• Gastrointestinal bleeding
• Esophageal perforation
• Infection
• Swallowing difficulty or dysphagia
• Aspiration pneumonia
• Vomiting and/or diarrhoea
• Airway obstruction or blockage due to balloon inflation and deflation
• Damage to the oesophagus from the tube itself, such as ulcers or tears

• After the procedure, patients should be monitored closely and given antibiotics to prevent infection.
• Patients should also be instructed on how to care for their Sengstaken Blakemore tube, including how to clean it and when to change it.
• It is also important for patients to maintain adequate hydration during recovery and avoid strenuous activity until they are fully healed.
• Patients should also be educated on the signs and symptoms of complications, such as pain or difficulty swallowing, so that they can seek medical attention if necessary.
• Additionally, follow-up appointments with their doctor may be necessary in order to monitor their progress and discuss any further treatment options.

The Sengstaken Blakemore tube is a medical device used to treat bleeding esophageal varices, which are enlarged veins in the oesophagus. It is inserted through the mouth and advanced into the stomach. The tube has a balloon at each end that can be inflated to compress the varices and stop bleeding.

It is an effective treatment for preventing life-threatening bleeding from varices, but it does come with risks such as aspiration of gastric contents, obstruction of the airway, and pressure necrosis of surrounding tissue. Careful monitoring and use of this device is essential to ensure successful outcomes.