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

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

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.
  

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.
  

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.

1. EMCrit – Blackmore tube placement

   
   

2. EM:RAP Video – Placement of a Blakemore Tube for Bleeding Variances (4:47)