Blakemore Tube Placement Checklist

Patient Preparation

  1. Review Indications and Contraindications
    Ensure the procedure is appropriate for the patient. (Indications: variceal bleeding, unresponsive to endoscopic/medical therapies).
    Contraindications: unprotected airway, esophageal rupture, recent EGJ surgery.

  2. Review Labs and Imaging

    • Confirm CBC, INR, and liver function tests.

    • Have relevant imaging ready.

  3. Prepare Equipment

    • Blakemore tube kit (tube, stopcocks, Christmas tree adapter).

    • 1 liter Normal Saline IV bag

    • Lubricant, syringes (50 cc), manometer, Kelly clamps.

    • Portable X-ray.

    • Endotracheal tube (ETT) holder or fastener.

Step-by-Step Procedure

1. Set up and Test Equipment

  • Assemble stopcocks and adapters to the Blakemore tube.

  • Test gastric and esophageal balloons:

    • Inject 50 cc air into each balloon. Submerge under water; check for leaks.

2. Patient Positioning

  • Position patient supine.

  • Ensure airway protection (intubated).

3. Lubricate and Insert Tube

  • Generously lubricate the Blakemore tube.

  • Insert tube oro/nasogastrically to the 50 cm mark.

4. Confirm Gastric Balloon Placement

  • Inflate gastric balloon with 50 cc air.

  • Confirm placement:

    • Endoscopy (preferred) OR

    • Portable X-ray: confirm balloon below the diaphragm.

  • Once confirmed, inflate gastric balloon to 250 cc total.

5. Apply Tension

  • Tie one end of Kerlex gauze to the Blakemore tube and the other to a 1L IV fluid bag.

  • Hang IV bag over IV pole to create tension.

6. Mark and Secure

  • Mark the Blakemore tube at the lip/nares for migration monitoring.

  • Use an ETT holder to secure the tube and prevent pressure injury.

7. Esophageal Balloon Inflation (If Needed)

  • Attach manometer to the esophageal balloon port.

  • Inflate to 30-45 mmHg (or 48-61 cm Hâ‚‚O).

  • Confirm placement with X-ray.

8. Post-Procedure Monitoring

  • Connect gastric aspiration port to low intermittent suction.

  • Flush gastric port with 50 cc saline every hour to maintain patency.

  • Monitor balloon pressures hourly to avoid necrosis.

Critical Safety Notes

  • Monitor for tube migration: Assess tube marking every 1-2 hours.

  • Esophageal Balloon: Deflate every 6 hours for 15 minutes to reduce necrosis risk.

  • Re-bleeding: Re-inflate esophageal balloon immediately if necessary.

Troubleshooting Tips

  • Difficult Tube Insertion:

    • Chill tube in an ice bath.

    • Stiffen with ET stylet or biopsy forceps.

  • No Stopcocks? Use Kelly clamps and a syringe directly.

  • Endoscopic Assistance: Recommended for safety.

Clean-Up and Documentation

  1. Ensure bed/patient is restored to pre-procedure state.

  2. Document the procedure in the EMR system, mention:

    • Location confirmation

    • Balloon volumes

    • Radiographic confirmation