LEARNNG POCKET DESCRIPTION

- This learning packet discusses Sengstaken-Blakemore Tube insertion. It

comprises the indications, contraindications and the procedure for insertion
- It also discusses Endoscopy. It comprises the types, indications, risks and the procedure.

LEARNING OUTCOMES

After this lesson, the students will be able to:

1. Identify the indications, contraindications and complications of Sengstaken-

Blakemore Tube and for patients for Endoscopy.
2. Plan the care for a patient with Sengstaken tube and for patients for Endoscopy

3. Identify the types of Endoscopy.

4. Determine related factors to formulate nursing diagnoses based on the status of a

patient.

CONTENT

Sengstaken-Blakemore

 Used to stop or slow bleeding from the esophagus and stomach

 The bleeding is typically caused by gastric or esophageal varices, which are veins that have
swollen from obstructed blood flow.
 A variation of the SB tube, called the Minnesota tube, can also be used to decompress or drain
the stomach to avoid insertion of a second tube called a nasogastric tube.

 The SB tube has three ports at one end, each with a different function:

 esophageal balloon port, which inflates a small balloon in the esophagus

 gastric aspiration port, which removes fluid and air out of the stomach
 gastric balloon port, which inflates a balloon in the stomach

 At the other end of the SB tube are two balloons. When inflated, these balloons put pressure on
the areas that are bleeding to stop blood flow.

 The tube is typically inserted through the mouth, but it can also be inserted through the nose to
reach the stomach.

 Doctors will remove it once the bleeding has stopped.

 In the following cases, doctors advise against using the SB tube:

 Variceal bleeding stops or slows down.

 The patient recently had surgery involving the esophagus or stomach muscles.
 The patient has a blocked or narrowed esophagus.

Procedure:

 A doctor can insert the SB tube through the nose, but it’s more likely to be inserted through the
mouth.

 Prior to inserting the tube, you would usually be intubated and mechanically ventilated to
control your breathing.

  IV fluids are given to maintain blood circulation and volume

 The doctor then checks for air leaks in the esophageal and gastric balloons found at the end of
the tube. To do this, they inflate the balloons and place them in water. If there are no air leaks,
the balloons will be deflated.

 The doctor also needs to insert a Salem sump tube for this procedure to drain the stomach.

 The doctor measures these two tubes to ensure accurate placement in the stomach. First, the
SB tube must be properly positioned in the stomach. They next measure the Salem sump tube
against the SB tube and mark it at the desired point.
 After measuring, the SB tube must be lubricated to ease the insertion process. The tube is
inserted until the mark made by the doctor is at your gums or opening of your mouth.

 To ensure the tube reaches your stomach, the doctor inflates the gastric balloon with a small
amount of air. They then use an X-ray to confirm proper placement. If the inflated balloon is
positioned correctly in the stomach, they inflate it with additional air to reach the desired
pressure.

 Once they insert the SB tube, the doctor connects it to a weight for traction. The added
resistance may cause the tube to stretch. In this case, they need to mark the new point where
the tube leaves your mouth. The doctor also needs to pull the tube gently until they feel
resistance. This indicates the balloon is properly inflated and applying pressure to the bleeding.

 After feeling resistance and measuring the SB tube, the doctor inserts the Salem sump tube.
Both the SB tube and the Salem sump tube are secured after placement to prevent movement.

 The doctor applies suction to the SB aspiration port and the Salem sump to remove any blood
clots. If bleeding continues, they may increase the inflation pressure. It’s important not to
overinflate the esophageal balloon so it doesn’t pop.

 Once the bleeding has stopped, the doctor performs these steps to remove the SB tube:

1. Deflate the esophageal balloon.

2. Remove traction from the SB tube.
3. Deflate the gastric balloon.
4. Remove the SB tube.
 Share on
Pinterest

ADVERTISING

Potential Complications

 There are a few risks associated with using the SB tube:

 You can expect some discomfort from the procedure, specifically a sore throat if the tube was
inserted through the mouth. If placed incorrectly, the SB tube can affect your ability to breathe.

 Other complications from incorrectly positioning this tube or ruptured balloons include:

 hiccups
 pain
 recurrent bleeding
  aspiration pneumonia, an infection that occurs after you breathe food, vomit, or saliva into
the lungs
 esophageal ulceration, when painful ulcers form in the lower portion of the esophagus
 mucosal ulceration, or ulcers that form on mucous membranes
 acute laryngeal obstruction, or a blockage in your airways that restricts oxygen intake

Endoscopy

 is the insertion of a long, thin tube directly into the body to observe an internal organ or tissue
in detail. It can also be used to carry out other tasks including imaging and minor surgery.
 Endoscopes are minimally invasive and can be inserted into the openings of the body such as
the mouth or anus.

 Alternatively, they can be inserted into small incisions, for instance, in the knee or abdomen.
Surgery completed through a small incision and assisted with special instruments, such as the
endoscope, is called keyhole surgery.

 Endoscopy is useful for investigating many systems within the human body; these areas include:

 Gastrointestinal tract: esophagus, stomach, and duodenum

(esophagogastroduodenoscopy), small intestine (enteroscopy), large intestine/colon
(colonoscopy, sigmoidoscopy), bile duct, rectum (rectoscopy), and anus (anoscopy).
 Respiratory tract: Nose (rhinoscopy), lower respiratory tract (bronchoscopy).
 Ear: Otoscopy
 Urinary tract: Cystoscopy
 Female reproductive tract (gynoscopy): Cervix (colposcopy), uterus (hysteroscopy), fallopian
tubes (falloposcopy).
 Through a small incision: Abdominal or pelvic cavity (laparoscopy), interior of a joint
(arthroscopy), organs of the chest (thoracoscopy and mediastinoscopy).

Preparation
 The procedure does not require an overnight stay in the hospital and usually only takes around
1 hour to complete. The doctor will provide instructions about the preparation for the
procedure.

 For many types of endoscopy, the individual needs to fast for around 12 hours, though this
varies based on the type.

 For procedures investigating the gut, laxatives may be taken the night before to clear the
system.

 A doctor will carry out an examination before the endoscopy. It is important to mention all
current medications (including supplements) and any previous procedures.

Procedure

 The procedure will depend to some extent on the reason for the endoscopy.

 There are three main reasons for carrying out an endoscopy:

 Investigation: If an individual is experiencing vomiting, abdominal pain, breathing disorders,

stomach ulcers, difficulty swallowing, or gastrointestinal bleeding, for example an endoscope
can be used to search for a cause.
 Confirmation of a diagnosis: Endoscopy can be used to carry out a biopsy to confirm a
diagnosis of cancer or other diseases.
 Treatment: an endoscope can be used to treat an illness directly; for instance, endoscopy
can be used to cauterize (seal using heat) a bleeding vessel or remove a polyp.

 Sometimes, endoscopy will be combined with another procedure such as an ultrasound scan. It
can be used to place the ultrasound probe close to organs that can be difficult to image, such as
the pancreas.

 Modern endoscopes are sometimes fitted with sensitive lights that use narrow band imaging.
This type of imaging uses specific blue and green wavelengths that allow the doctor to spot
precancerous conditions more easily.
 An endoscopy is typically performed while the patient is conscious, although sometimes the
patient will receive local anesthetic (commonly an anesthetic spray to the back of the throat);
often, the patient is sedated.

 For endoscopy procedures involving entry through the mouth, a mouth guard will be used to
protect the teeth and lips as the tube is inserted.

Endoscope use in surgery

S
hare on

 Endoscopy has advanced in recent years, enabling some forms of surgery to be conducted using
a modified endoscope; this makes the surgery less invasive.

 Procedures such as the removal of the gallbladder, sealing and tying the fallopian tubes and the
removal of small tumors from the digestive system or lungs are now commonplace.

 A laparoscope is a modified endoscope used for keyhole surgery (also referred to as

laparoscopic surgery).
  Laparoscopic surgery requires only a small incision and can be used for appendectomies
(removal of the appendix), hysterectomies (removal of the uterus) and prostatectomies
(removal of prostate tissue).

 Using this technique, patients lose less blood during and after surgery and can recover
much faster compared with standard surgical procedures.

Risks and side effects

(Endoscopy is a relatively safe procedure, but there are certain risks involved. Risks depend on the
area that is being examined)

 Risks of endoscopy may include:

 over-sedation, although sedation is not always necessary

 feeling bloated for a short time after the procedure
 mild cramping
 a numb throat for a few hours due to the use of local anesthetic
 infection of the area of investigation: this most commonly occurs when additional
procedures are carried out at the same time. The infections are normally minor and
treatable with a course of antibiotics
 persistent pain in the area of the endoscopy
 perforation or tear of the lining of the stomach or esophagus occurs in 1 in every 2,500-
11,000 cases
 internal bleeding, usually minor and sometimes treatable by endoscopic cauterization
 complications related to preexisting conditions

 Any of the following symptoms should be reported to a doctor:

 dark colored stool

 shortness of breath
 severe and persistent abdominal pain
 chest pain
 vomiting blood
Recovery

 Recovery will depend on the type of procedure. For an upper endoscopy, which is used to
enable a doctor to examine the upper gastrointestinal tract, the patient will be observed for
some time after the procedure, usually around one hour, while any sedative medication wears
off.

 The person should not usually work or drive for the rest of the day, because of the sedative
effect of the medication used to prevent the pain.

 There may be some soreness. With this type of endoscopy, there may be bloating and a sore
throat, but these usually resolve quickly.