The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:
A. Check that the hemostat is on the bedside.
B. Monitor IV fluids for the shift.
C. Regularly assess respiratory status.
D. Check that the balloon is deflated on a regular basis.
Correct Answer: C. Regularly assess respiratory status.
The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.
Option A: Variceal band ligation is preferred to sclerotherapy for bleeding varices and for non-bleeding medium-to-large varices to decrease bleeding risk. Ligation has lower rates of rebleeding, fewer complications, more rapid cessation of bleeding, and a higher rate of variceal eradication.
Option B: Treat coagulopathy as necessary. Fresh frozen plasma may increase blood volume and increase rebleeding risk. IV octreotide to lower portal venous pressure as adjuvant to endoscopic management. An IV bolus of 50 micrograms followed by a drip of 50 micrograms/hr.
Option D: If endoscopic treatment fails, consider self-expanding esophageal metal stents or peroral placement of Sengstaken-Blakemore-type tubes for up to 24 hours to stabilize the patient for TIPS. As many as two-thirds of patients with variceal bleeding develop an infection, most commonly spontaneous bacterial peritonitis, UTI, or pneumonia. Antibiotic prophylaxis with oral norfloxacin 400 mg or IV ceftriaxone, 1 g q24h for up to a week, is indicated.
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