Page 186 - Critical Care Notes

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GI
■ Prepare patient for endoscopic variceal ligation/banding or application of
hemoclips.
■ Prepare patient for transjugular intrahepatic portosystemic shunt (TIPS) or
endoscopic injection. Percutaneous TIPS is an interventional procedure to
decrease portal hypertension and reduce complications of high hepatic
pressures. A catheter is placed in a hepatic vein, and a stent is placed in the
liver parenchyma. After the procedure: Observe for bleeding from hepatic
or portal vein puncture, puncture of the biliary tree, bile duct trauma, and
stent migration or thrombosis.
■ Prepare patient for esophageal variceal band ligation, esophageal transec-
tion, or surgical bypass procedure: Portacaval shunt, mesocaval shunt, or
splenorenal shunt.
■ Refer to assessment and management discussions in Acute Gastrointestinal
Bleeding.
Esophagogastric Balloon Tamponade
■ Esophagogastric balloon tamponade is used to control esophageal variceal
bleeding through use of the Sengstaken-Blakemore tube or Minnesota tube.
A Linton-Nachlas tube is used for isolated gastric hemorrhage, such as
with gastric varices. The balloons apply direct pressure to the varices →
↓ blood flow and stop variceal bleeding.
■ The Sengstaken-Blakemore tube has three lumens: gastric aspiration,
esophageal balloon inflation, and gastric balloon inflation. The Minnesota
tube has a fourth lumen for esophageal aspiration. The inflation of the
balloons is as follows or per policy:
■ The esophageal balloon is inflated to 25–35/40 mm Hg pressure for a
maximum of 24 hr. Note pressure on manometer.
■ The gastric balloon is inflated in 100-mL increments to 25–500 mL of air
or as specified by manufacturer. Note pressure on manometer.
■ Never inflate the esophageal balloon before the gastric balloon.
■ 1–3 lb of pressure is used for tension or traction on the balloons by using
a pulley system with a 500-mL bag of IV fluid, a football helmet, or a
foam rubber cuff.
■ One port is connected to intermittent suction.
Nursing Management of Esophageal Balloon
Tamponade
■ Confirm placement by chest x-ray.
■ Assess airway patency and signs of respiratory distress. Sudden rupture of
balloon → airway obstruction and pulmonary aspiration of gastric contents
and asphyxiation.
■ Scissors should be placed at the bedside for cutting the balloons if airway
is obstructed.
■ Position patient in high-Fowler’s position or on left side.
■ Provide frequent oral and nares care and oral suction.
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