Variceal Tamponade: Teaching New Dogs Old Tricks! A Performance Improvement Project

Abstract

Introduction: Acute esophageal variceal hemorrhage is a dreaded complication of chronic liver disease that nearly every endoscopist will encounter during their career. In the event of failed endoscopic treatment, it is vital for one to be knowledgeable on the proper use and placement of balloon tamponade as a bridge to repeat endoscopy or transjugular intrahepatic portosystemic shunt procedure. There are many obstacles that can make the use of balloon tamponade more challenging, such as maintaining the knowledge and skill for placement given rarity of use, locating all necessary required components for proper function (these are not provided from the tube manufacturer), and educating the team and ancillary staff on tube care post-placement. Our aim in this project was to standardize the balloon tamponade process by re-educating our gastroenterology providers on tube placement and developing a balloon tamponade “kit” containing all required accessories and instructions to improve the ease and safety when this emergency intervention is required. Methods: We devised a five-question pre and post-intervention survey to test our seven staff gastroenterologists and six fellows on their knowledge of locating all components of the balloon tamponade tube, details of tube placement, and post-placement tube instructions. The intervention included introduction of our new tube kit along with a one-on-one, 20-25 minute demonstration of tube assembly, placement, troubleshooting, and post tube care instructions. We then measured improvement between pre and posttest surveys using a paired t-test. Results: There was a statistically significant improvement in confidence with each tested component of our survey, as well as for the entire group of questions post-education intervention (P<0.001), see Table 1.Table: Table. Pre/Post Test SummaryConclusion: Our balloon tamponade project was a success in standardizing the use of this device. It was also effective in refreshing our providers on proper tube placement, use, and post-placement tube care. Moving forward, our institution will continue to utilize this balloon tamponade kit until newer options become standard of care. Sample size may have been a limitation in our study. In the future, we are planning to reproduce this project to include the internal medicine residents who are typically first line in acute variceal hemorrhage cases prior to gastroenterology consultation and are usually involved in tube placement.