Novel Use of Glidescope Indirect Laryngoscopy for Insertion of a Minnesota Tube for Variceal Bleeding

Adam B. Schlichting, MD, MPH; Jayna M. Gardner-Gray, MD; Gina Hurst, MD

Disclosures

J Emerg Med. 2015;49(1):40-42. 

In This Article

Discussion

Technique

A consistent method for insertion of the Minnesota tube (C. R. Bard, Covington, GA) was employed in all cases. Due to large-volume hematemesis, all patients had been endotracheal intubated to protect their airway. The Minnesota tube was placed in a bedside ice bath to transiently improve rigidity of the tube. Before insertion of the tube, serial volumes of air were injected into the gastric and esophageal ports, and corresponding pressures were recorded. All patients were then sedated and paralyzed using cisatracurium. The Glidescope (Verathon Inc., Bothell, WA) was inserted into the patient's mouth and the proximal esophagus was visualized (see Figure 1). Although we experienced no hematemesis, we had two Yankauer suction catheters available in case it should occur. The Minnesota tube was removed from the ice bath, quickly coated with water-based lubricant, then inserted through the patient's mouth. Using indirect visualization via the Glidescope, the tip of the Minnesota tube was directed down the esophagus with the assistance of either Magill forceps or the operator's fingers. Indirect visualization of the oropharynx was maintained throughout insertion of the tube to a depth of 50 cm to ensure the Minnesota tube had not coiled in the mouth. Radiographic confirmation that the Minnesota tube was within the stomach was obtained. The gastric balloon was then inflated with 100 mL of air and manometry was measured to ensure the pressure was within 10 mm Hg of the pre-insertion pressure; a deviation of > 10 mm Hg between pre-insertion and post-insertion being indicative of inflation of the gastric balloon within the esophagus. Repeat radiographic confirmation was obtained and then subsequent volumes of air were then inflated, checking manometry after each 100 mL, to a total volume of 500 mL of air in the gastric balloon. Traction was then applied to the Minnesota tube and a 1 L bag of normal saline (providing 1 kg of traction) was tied to the Minnesota tube and hung from the end of the bed. Hemostasis was achieved in all cases without inflation of the esophageal balloon.

Figure 1.

Indirect visualization of (A) Minnesota tube and (B) endotracheal tube via Glidescope indirect videolaryngoscopy. Epiglottis is denoted by (C).

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