Bakri Ballon

(Ballon Tamponade)

<Procedures>   <Equipment>

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Definition

-  Ballon catheter used for uterine tamponade in PPH not responding to uterotonics

 

Features

-  54cm long, 24 French silicone catheter with inflatable balloon on a double lumen shaft

-  Central lumen allows drainage

-  Outer lumen allows inflation

-  Balloon holds 500ml (0.9% NaCl)

-  Reduces need for further surgical intervention in major PPH

-  Typically left in 8-24hrs to allow blood transfusion & correction of any coagulopathy

-  Takes on average 6hrs for placental bed to clot & cease bleeding

 

Indications

-  PPH not responding to uterotonics

 

Contraindications

-  Cervical ca

-  Uterine anomalies

-  Uterine rupture

-  Suspected arterial bleeding

 

Equipment

-  Bakri Balloon

-  Speculum: Sims

-  50ml syringe

-  500ml NS 09.%

 

 

Insertion Procedure

-  Should be inserted in theatre

-  Analgesia: GA, Epidural +/- pudendal blocks

-  Empty bladder: in-out or IDC

-  Ensure empty uterus: placenta complete, nil large clots

-  Insert Sims speculum

-  Insert Bakri balloon under visual guidance using spongue forceps

-  +/- US guided

-  Inflate progressively to 300ml

-  Ensure retenion of balloon within uterus as cervix may be lax (fully dilated)

-  Assess haemostasis

-  Observe drainage from ballon catheter central lumen

-  If bleeding continues surgical intervention required

-  If bleeding controlled secure in place

-  Document: procedure, volume of NS used for inflation

-  Usually monitored in HDU post insertion

-  NBM until balloon removed (in case of surgery)

-  1/24 obs, outputs & fundal height until stable

-  Syntocinon 40 IU over 4hrs

-  IV antibiotics until Bakri removed

-  Amoxycillin 2g IV loading dose then 1g IV 4/24

-  Metronidazole 500mg IV 12/24

-  Gentamicin 5mg/kg single stat dose

-  Adequate analgesia until removal

 

Removal Procedure

-  Consider removal after 8hrs minimum

-  Ensuring stable loss via drain & obs stable

-  Deflated in stages

-  Aspirate 150ml

-  Observe for 30min

-  If stable aspirate remaining 150ml

-  Monitor PV loss

 

 

 

References

 

Pic: www.microtech-medical.com/en/pro_info.asp?nid=553

SA Perinatal Practice Guidelines, Chapter 89: Balloon Tamponade & Uterine Packing for Major PPH, 22/05/12