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(1/3) Blakemore insertions for variceal bleeds might seem daunting but typically are straightforward.. Until they aren't. This is the BEST trick I have seen for challenging Blakemore insertions. Use a bougie to help make the tip of the Blakemore more rigid in the posterior oropharynx. This was filmed at... show more
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(2/x) I think of Blakemore Tubes as a large OG with a bunch of confusing ports. Here are some tips: 1. Read the instruction manual - every model has a different amount of air that needs to be inserted. 2. If you are having difficulty passing it through the oropharnyx, use a bougie as shown in the video above. 3. Remember the 50-50 rule. Insert the Blakemore to at least 50cm depth, inflate with 50mL of air, and get an x-ray to confirm that the balloon is in the stomach BEFORE you add inflate to 500mL total (again check your model for exact volume of air) 4. McGill forceps can help with passing the oropharynx, however, I find the bougie even more useful. 5. MOST patients do not need the esophageal balloon inflated - gentle traction on the gastric balloon should tamponade most bleeds. 6. If you are inflating the esophageal balloon, this is done by pressure not volume. You can use the ETT cuff pressure checking device to check (again - read instructions / local protocols for optimal pressure as this varies a bit) 7. Don't be afraid of the Blakemore - compared to many other procedures in the ED/ICU this is pretty straightforward!
(3/3) If you want to get hands-on with Blakemore's, bronchoscopy, bronchial blockers, awake intubations and more, come check out #HR2025 conference in Montreal May 22/23rd (with lots of pre and post courses too!). Registration: @katiewiskar @KiranRikhraj @ThinkingCC @khaycock2 @G2Disrupt
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Do they still use a football helmet with a face mask to maintain traction 🙃
Some centers do! We use a pulley system with a 1L bag of IV fluids
Love this and will def keep it in mind for next time! I’ve used ice and it worked wonders after 1 failed insertion
Interesting technique, Ross! While the bougie approach can help, are there any potential risks or complications to be mindful of when using this method? How do you ensure that the rigidity doesn't lead to unintended injuries, especially in complex cases? For anyone seeking deeper insights or developing alternate methods for procedures like Blakemore insertions, I'd recommend checking out It’s a great resource for generating comprehensive biomedical reviews. #Medicine
Nice one. The trick I learned years ago was intubate first, then there is only one hole to aim. These days VL makes the one hole method even better.
@mtanzi2791 sounds familiar
Do you leave the bougie in place and just lose that port? Seems like tube would come w/ it if you tried to then remove bougie
I don’t put it quite as far into the Blakemore as shown here - don’t have any issues accidentally removing the blakemore with the bougie
