Placement over an orogastric tube with balloon tamponade capabilities designed for the management of esophageal or gastric bleeding. Specifically devices include the sengstaken-blakemore tube, minnesota tube, and linton-nachlas tube
Ideally, the patient should be sedated and intubated prior to performing this procedure due to the pain and difficulty
A manometer should be used to measure endotracheal cuff pressures to decrease the risk of perforation. If you do not have a standadr manometer, you can instead use a sphygmanometer (detached from standard BP cuff)
Filling the foley catheter with barium ahead of time can help identify the location of the catheter on X-ray if needed.
A reasonable alternative to a foley catheter would be a magnet attached Levine catheter, which has the added benefit of being able to reach deeper in the esophagus and even into the stomach or duodenum
Replacement of gastrostomy tube (G-tube) for purposes of continued nutrition/medication for patients. Should be treated as a medical emergency, as tube tracts can close narrow or close within hours of tube removal.
G-tubes with established tracts. If G-tube has be recently been established (within last 3 weeks), attempts to replace may cause separation of the stomach from the abdominal wall.
Newly established G-tubes (within 3 weeks). Must consult the physician who placed it.
Any evidence of infection (erythema, warmth, exudate)
Misplacement of G-tube into peritoneal cavity (may be lethal), placement too far into the proximal duodenum, infection
If the stoma from the G-tube site has already started to close, you can try inserting a smaller sized tube to salvage the site.
Abdominal X-ray should be used after reinsertion to ensure the G-tube was not inadvertently placed into the abdominal cavity.
Signs of leakage from drug packets (ex. Tachycardia, hypertension, respiratory depression, hyperthermia)
Injuries from nasogastric tube insertion, hypersensitivity reactions, nausea/vomiting
Whole bowel irrigation is not routinely recommended for GI decontamination according to the AACT and EAPCCT. However, it may be useful if the ingested material is not well adsorbed by activated charcoal (lithium, iron, metals, etc.)
Polyethylene glycol (PEG) use during whole bowel irrigationsignificantly reduces the the binding capacity of activated charcoal.