Insertion technique

The tubes are usually kept in the fridge to provide added stiffness for easier insertion.

1. The patient often requires judicious sedation or mechanical ventilation (as warranted by conscious state/level of agitation) prior to insertion.

2. Check balloons inflate properly beforehand. Lubricate end of tube.

3. Insert via mouth. Place to depth of 55-60cm, i.e. to ensure gastric balloon is in stomach prior to inflation.

4. Inflate gastric balloon with water to volume instructed by manufacturer (usually *200ml). A small amount of radio-opaque contrast may be added. Negligible resistance to inflation should be felt. Clamp gastric balloon lumen.

5. Pull tube back until resistance is felt, i.e. gastric balloon is at cardia. Fix tube in place by applying counter-traction at the mouth. Old-fashioned methods, such as attaching the tube to a free-hanging litre bag of saline, have been superseded by more manageable techniques. For example, two wooden tongue depressors, 'thickened' by having Elastoplast wound around them, are placed either side of the tube at the mouth and then attached to each other at both ends by more Elastoplast. The tube remains gripped at the mouth/cheek by the attached tongue depressors but can be retracted until adequate but not excessive traction is being applied.

6. Perform X-ray to check satisfactory position of gastric balloon.

7. If bleeding continues (continued large aspirates from gastric or oesophageal lumens), inflate oesophageal balloon (approx 50ml).

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