CMSRN Procedures Practice Questions (110 Flashcards)

Immediate action: Cut all lumens of the tube with scissors (kept at the bedside) and remove the tube. Rationale: Respiratory distress in a patient with a balloon tamponade tube is usually caused by upward displacement of the gastric balloon, which then occludes the airway. Cutting the tubes allows for rapid deflation and removal to restore the airway. Clinical Pearl: Always ensure a pair of scissors is taped to the head of the bed or is immediately accessible at the bedside; this is a standard safety requirement for any patient with balloon tamponade.

Recommended pressure: 25 to 45 mmHg. Rationale: The pressure must be high enough to compress the varices but low enough to prevent esophageal wall ischemia and necrosis. Pressures are monitored via a manometer. Pressures exceeding 45 mmHg significantly increase the risk of esophageal perforation. Clinical Pearl: Esophageal balloon pressure should be checked every 2–4 hours. It is often deflated periodically (e.g., for 30-60 minutes every 8-12 hours) per facility protocol to assess for re-bleeding and allow for temporary tissue perfusion.

Gastric Balloon: Primarily serves to anchor the tube at the gastroesophageal junction and applies pressure to the gastric cardia varices. It is inflated first (usually 250–500 mL of air). Esophageal Balloon: Provides direct pressure (tamponade) to bleeding esophageal varices. Rationale: The gastric balloon must be fully inflated and pulled snug against the cardia before the esophageal balloon is inflated to ensure proper positioning. Clinical Pearl: Always confirm gastric balloon placement via X-ray before full inflation to avoid inflating it in the esophagus, which could cause rupture.

Sequence: Deflate the esophageal balloon first, followed by the gastric balloon. Rationale: The esophageal balloon is deflated to monitor for re-bleeding while the tube remains anchored by the gastric balloon. If no bleeding occurs after a trial period (typically 12-24 hours), the gastric balloon is deflated and the tube is removed. Clinical Pearl: The tube is a temporary measure (maximum 24 hours) used as a bridge to more definitive therapy like TIPS (Transjugular Intrahepatic Portosystemic Shunt) or endoscopic ligation. Deflation must be done slowly and under close observation.

Intervention: Maintain constant traction using a pulley system with weights (usually 0.5 to 1.5 lbs) or a foam sponge/block at the nare. Rationale: Traction keeps the gastric balloon firmly against the gastroesophageal junction, preventing the tube from slipping down or moving up into the airway. Clinical Pearl: Excessive traction can cause pressure ulcers at the nare or necrosis of the gastric mucosa. Monitor the skin at the insertion site frequently. If a pulley system is used, ensure the weights hang freely and are not resting on the floor or bed frame.