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Discussion

How Do You Stop a GI Bleed?

I'm writing an extra credit paper about a scenario in which a patient with cirrhosis and esophageal varices presents in the ER with an upper GI bleed. While I understand the assessment, labs and interventions to determine the effects of his blood loss and how to maintain his hemodynamic stability, I've no clue as to what nursing interventions I could take to stop his GI bleeding--it's not like I could use a tourniquest or apply pressure to his GI system. ANY help would be appreciated. Thanks--

Featured Replies

I am only first semester so don't listen to me if this is way off. Does the patient smoke? Coughing could break open the varices, so maybe some sort of teaching plan for that?? It's not going to stop it but possibly prevent in the future. I'll be interested to see the responses to this :)

Tracy

I'll over step my boundaries as a pre-nursing student and offer this answer. Two of my instructors talked about this last term and said an upper GI bleed is treated with an iced saline lavage.

Dave

Excellent article. Watch your ABC's. Continuous telemetry and pulse oximetry, strict bedrest, NPO, high Fowlers, O2 with humidification as needed. Draw labs: CBC with diff, type and cross match for 4 units PRBC. At least two large bore IV's. Prepare for gastric intubation with saline lavage or esophagogastric balloon tamponade, transfusion of PRBC and fresh frozen plasma, and octreotide (Sandostatin) drip.

  • Expert

Iced saline lavage is not used anywhere, anymore. Room temp only for the saline.

Blakemore-type tubes are usually used to tamponade off the bleeding varices. Once the patient has an EGD done by the GI doctors, the bands are applied to the varices, and no NG is placed for at least seven days to prevent a recurrance of the bleeding. However, if the bleeding spontaneously starts again, then an NG tube can be placed. Adn the process starts over again.

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