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Oesophageal haemhorrage is a life-threatening condition, but it can be stemmed by the use of the Sengstaken tube. Patricia McCaffrey explains the technique for insertion and the need to monitor the patient.
The present high degree of safety of enteral nutrition is due to improvements in commercial nutritional products and, chiefly, to the respect of well-established rules of administration. Monitoring the equipment consists of making sure, by means of repeated rinsing, that the fine digestive tract prosthesis remains patent. Nutrients are now sterile and easy to use, and their compositions varied and well-balanced. They are very well tolerated in most cases. Monitoring the speed of gastrointestinal (GI) transit is crucial. One must watch for the occurrence of multiple daily stools, due to the speed of administration or to malabsorption, proliferation of exogenous or endogenous pathogens or patient's underlying pathology, and for a gastric fluid residual volume exceeding 150 ml. Regular controls of gastric emptying and of GI prosthesis position prevent the very rare complications that are aspiration pneumonia and unexplained chronic dyspnoea. Possible interference between enteral nutrition and patient's pathology or treatment must be detected and prevented.
Continuous gastric cooling (CGC) with dialysate was done in nine hemodiaysis patients with massive gastro-intestinal (GI) bleeding. Eight patients were treated by direct irrigation using a double-lumen naso-gastric (NG) tube without balloon. Four patients with bleeding from the duodenum (B-f-D) had complete hemostasis, and there was only one recurrence. However, two out of four patients with bleeding from the stomach (B-f-S) had complete hemostasis, but all four suffered recurrence. The NG tube had to be reinserted in three patients with B-f-S because of obstruction by clots. The direct irrigation method of CGC thus appears to be more effective for the treatment of B-f-D than B-f-S, so we investigated a three lumen, single-balloon catheter (3L-SBC) with which the bleeding site in the stomach can be cooled and pressed without removing coagula. CGC using the 3L-SBC was done in one patient with B-f-S, and complete hemostasis was obtained without recurrence.
The management of patients after uncomplicated elective gastrointestinal operations is frequently left to junior members of the surgical team once they have learnt their seniors' regimens. The use of nasogastric (N/G) tubes, the volume of intravenous (IV) fluid replacement and the reintroduction of oral fluids and solids are topics not generally covered in the surgical textbooks and so are learnt in hospital. A postal survey of all consultant general surgeons in Scotland was conducted to assess the variations in management of patients after cholecystectomy, right haemicolectomy and sigmoid colectomy. A completed questionnaire was received from 111 (81%) of the surgeons circulated. As might be expected, patient management varied widely from surgeon to surgeon, and from unit to unit. There would appear to be a need for prospective studies in this area of patient management. This may indicate that the use of N/G tubes could be further reduced and that oral fluids and solids could be reintroduced sooner after operation with improved patient comfort and reduced hospital stay, yet without detriment to patient care.
The Sengstaken-Blakemore (SB) tube is a valuable tool in the emergency treatment of patients with bleeding oesophageal varices. However, as its use may be associated with a number of serious complications it should be used judiciously and inserted with care. Once bleeding has been controlled with an SB tube, definitive treatment for the bleeding varices should be urgently considered.
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We are describing a complication of the usage of Sengstaken-Blakemore tubes. Premature inflation of the gastric balloon in the esophagus can lead to rupture of the esophagus. This hazard can be avoided by checking the position of the tube with a chest radiograph before attempting to inflate the tamponading balloons.
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The majority of gastro-intestinal investigations cause disturbances of secretion or gastric tonicity and motility, which can interfere considerably with the examination. It is therefore essential for the doctor to prevent these disorders by equilibrating the gastro-intestinal function. Primperan is incontestably the molecule of choice in this field, because of the specificity and the constancy of its action in the gastro-intestinal tract and because of its excellent tolerance.
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