Patient Care for Esophagogastric Balloon Tamponade Tubes
Writing Assignment #7
Tiara Diaz
ITT Technical Institute/Breckinridge School of Nursing
NUR 270
Jennifer Kyte APRN, MSN
May 7th, 2012
The plan of care for a patient with esophagogastric balloon tamponade tubes is formulated around the primary nursing diagnosis of ineffective airway clearance related to aspiration of blood (Ackley, B., Ladwig, G., 2011) Bleeding often stop spontaneously, but if it does not, a Sengstaken-Blakemore or Minnesota tube is inserted to provide constant pressure at the source of bleeding of the varices by using a balloon tamponade. For continued bleeding, a nasogastric tube may be inserted and connected to continuous low suction with periodic lavages. Intra-arterial infusion of vasopressin or therapeutic embolization into the left gastric artery during arteriography has also shown to be effective in controlling bleeding in some patients. Other techniques to stop bleeding include endoscopy with electrocoagulation for hemostatsis or transcatheter embolization with an autologous blood clot or artificial material, such as a gelatin sponge. On rare occasions the patient may require surgery to suture the laceration. If the patient has excessive blood loss, the nurse should institute protocols to support the circulation such as the administration of intravenous (IV) fluids and blood component therapy. With continued or massive bleeding the patient may need to be supported with blood transfusions and admitted to an intensive care unit (ICU) for close observation. A major cause of morbidity and mortality in patients with active gastrointestinal (GI) bleeding is aspiration of blood with subsequent respiratory compromise. This is usually seen in patients with inadequate gag reflexes or those who or are unconscious or obtunded. Constant observation to ensure a patent airway is vital. The patient must be checked every eight hours for the presence of a gag reflex. The head of the bed should be maintained in a high fowler
Tiara Diaz
ITT Technical Institute/Breckinridge School of Nursing
NUR 270
Jennifer Kyte APRN, MSN
May 7th, 2012
The plan of care for a patient with esophagogastric balloon tamponade tubes is formulated around the primary nursing diagnosis of ineffective airway clearance related to aspiration of blood (Ackley, B., Ladwig, G., 2011) Bleeding often stop spontaneously, but if it does not, a Sengstaken-Blakemore or Minnesota tube is inserted to provide constant pressure at the source of bleeding of the varices by using a balloon tamponade. For continued bleeding, a nasogastric tube may be inserted and connected to continuous low suction with periodic lavages. Intra-arterial infusion of vasopressin or therapeutic embolization into the left gastric artery during arteriography has also shown to be effective in controlling bleeding in some patients. Other techniques to stop bleeding include endoscopy with electrocoagulation for hemostatsis or transcatheter embolization with an autologous blood clot or artificial material, such as a gelatin sponge. On rare occasions the patient may require surgery to suture the laceration. If the patient has excessive blood loss, the nurse should institute protocols to support the circulation such as the administration of intravenous (IV) fluids and blood component therapy. With continued or massive bleeding the patient may need to be supported with blood transfusions and admitted to an intensive care unit (ICU) for close observation. A major cause of morbidity and mortality in patients with active gastrointestinal (GI) bleeding is aspiration of blood with subsequent respiratory compromise. This is usually seen in patients with inadequate gag reflexes or those who or are unconscious or obtunded. Constant observation to ensure a patent airway is vital. The patient must be checked every eight hours for the presence of a gag reflex. The head of the bed should be maintained in a high fowler
References: Christensen, T., Christensen, M., (2007) The Implementation of a Guideline of Care for Patients with a Sengstaken-Blakemore Tube In Situ in a General Intensive Care Unit Using Transitional Change Theory Intensive Critical Care Nurse 4: 234-42 Collyer, T.C., (2008) Acute Upper Airway Obstruction Due to Displacement of a Sengstaken- Blakemore Tube European Journal of Anesthesiology 4: 341-2 Conn, H., Simpson, J., (1997) Excessive Mortality Associated with Balloon Tamponade of Bleeding Varices The Journal of the American Medical Association 7: 587-91 Matloff, D.S., (1992) Treatment of Acute Variceal Bleeding Gastroenteral Clinical of North America 1: 103-118 McEwen, D.R., (1996) Management of Alcoholic Cirrhosis of the Liver AORN Journal 2: 209-