Page 187 - Critical Care Notes

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■ Monitor lumen pressures, cardiac rhythm, VS, and respiratory status.
■ Consider sedation or restraints.
■ An optional NG tube may be inserted along the course of the Sengstaken-
Blakemore tube with the tip of the NG tube 3–4 cm proximal to the
esophageal balloon.
■ Monitor gastric and esophageal output. Maintain suction on ports. The bal-
loons may be deflated for about 30 min every 8–12 hr or per policy to
decompress the esophagus and stomach. Assess for bleeding.
■ The esophageal balloon must be deflated before the gastric balloon to pre-
vent upward migration of the esophageal balloon → airway occlusion.
■ To discontinue tamponade therapy, gradually decrease esophageal balloon
pressure. Observe for bleeding. If no further bleeding, then deflate the gas-
tric balloon. If no further bleeding within the following 4 hr, the tube may
be removed. Continue to monitor for bleeding.
Complications
■ Esophageal erosion and rupture → bleeding and shock
■ Pulmonary aspiration
■ Balloon migration resulting in asphyxiation
■ Nasal necrosis and mucosal ulceration
■ Hiccups
Institution-specific care:
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■
■
■
■

Hepatic Failure
Hepatic failure occurs when 60% of hepatocytes are lost. It may be chronic or
acute and can lead to hepatic encephalopathy or hepatic coma. Causes of
hepatic failure include:
■ Cirrhosis of the liver
■ Hepatitis A, hepatitis B, hepatitis C, Epstein-Barr virus, and other viral
infections
■ IV drug use, cocaine use, and acetaminophen toxicity

GI