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    Minnesota (Blakemore) Tube Insertion

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    Last Updated Oct 17, 2018
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    Context

    • This is a measure used pending definitive scope treatment by GI.

    Minnesota Kit Overview

    Step 1: Intubate

    Inubate patient then position the head of the bed at 45°.

    Steps 2: Check Balloon

    Check balloons for leakage.

    • Remove 1 plug each of gastric and esophageal balloon ports with Kelly clamps.
    • Connect Christmas Tree Adapter to the gastric balloon port.
    • Test by deflating and inflating the balloon with a 60cc syringe in gastric port. Fully deflate when satisfied there are no leaks. Then clamp.

    • Repeat with esophageal balloon port. Clamp.

    Step 3: Insert

    Insert.

    • Lubricate balloons.
    • Insert through the mouth until tube sits at the 50cm mark.
    • Release clamp of gastric balloon. Inflate gastric balloon with 50cc of air. Reclamp.
    • Obtain CXR to confirm placement below diaphragm.
    • If confirmed to be in stomach: inflate another 200-250cc in gastric ballon (up to 500cc for Minnesota).
    • Pull balloon back until it abuts the GE junction.
    • Secure with rope: slip knot around tube (or any knot).
    • Square knot through saline bag (or any knot).
    • Create pulley system by hanging saline bag over IV pole.
    • Mark tube at the lips (to monitor in case of balloon migration).
    • Connect both aspiration ports to wall suction.

    Step 4: For Ongoing Bleeding

    If ongoing bleeding: inflate esophageal balloon. (Note: rupture of esophagus due to over-distention is almost always fatal).

    • Inflate in 50-60cc aliquots of air (clamp in between while pulling air in syringe).
    • Check pressure with sphygmomanometer in between aliquots.
    • Pressure should be between 30-45mmHG.

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