Purpose: The goal of this guideline is to ensure the safety of patients and to provide the best care with the most expert staff available to perform emergent GEBT placement with a Minnesota or Sengstaken–Blakemore tube. MICU staff should be aware of the limited time the DEM staff have to assist with clinical services outside of the ED. Therefore, DEM staff should be called to the bedside only when the GEBT procedure is deemed to be definitely indicated.
Expected hours of coverage by DEM staff:
- Weekday night coverage: 5pm – 7am
- Weekend coverage: 3pm – 7am
Criteria to call DEM staff:
- During the expected hours of coverage IF
- MICU supervising fellow has not been “ signed off ” to do GEBT procedure per PCCM fellowship guidelines
- MICU staff has been called and can not be in house within 30 minutes
- GI service has been consulted and it is established that there will be no emergent EGD for banding and that balloon tamponade is necessary as a temporizing life saving measure
- Consent has been obtained
Procedure:
- Patient has been intubated
- Equipment for GEBT is at the bedside
- Call Category 1 staff phone: 16-8150 IF criteria are met
- Expected response time by DEM to MICU: 30 minutes
- Portable X-ray called to MICU upon arrival of ED staff
- DEM staff performs GEBT OR
- DEM resident or MICU Fellow performs GEBT with DEM staff supervising
Documentation:
DEM Staff documentation procedure:
- DEM staff physician will write the GEBT procedure note in EPIC
- DEM staff will write the attestation note and should include the name of the MICU fellow involved
MICU fellow documentation procedure:
- Fellow should not write a procedure note
- Fellow should write a progress note in which they should indicate the name of the supervising DEM staff
and that the service was Emergency Medicine
To download the January 2014 HFH Policy update please click below: