Sengstaken-Blakemore Tube Placement: A Simulation-Based Training Program for a High-Acuity, Low-Frequency Procedure

Variceal hemorrhage is a severe and often fatal consequence of portal hypertension from liver cirrhosis. Although endoscopic and radiographic interventions have largely replaced balloon tamponade, the Sengstaken-Blakemore tube (SBT) remains a critical salvage therapy. However, declining use has led to limited provider experience and familiarity with SBT placement and management.

We implemented a hands-on, manikin-based simulation program for fellows and attendings from gastroenterology and critical care to improve provider familiarity with SBT placement and management. Standardized SBT kits were developed and distributed across all sites. Annual simulation sessions included presession didactics, live demonstrations, and small-group hands-on practice. Pre- and postsession surveys assessed self-reported confidence in SBT placement, management, and removal using a 5-point Likert scale. A Wilcoxon signed-rank test analyzed changes in confidence.

Fifty-four participants participated in 2023. Prior to training, only 20% of participants reported having received any formal instruction on SBT placement or management and 39% had never placed an SBT in a real-life scenario. Confidence in SBT placement (mean 3.00-4.30), management (1.78-4.31), and removal (2.17-4.43) significantly increased after the simulation.

This simulation-based intervention was associated with improved self-reported confidence in SBT placement, management, and removal for a high-acuity, low-frequency procedure. Given interest, emergency medicine, surgery, and internal medicine were included in subsequent years. Our results underscore the importance of structured training in bridging knowledge and skill gaps across gastroenterology and critical care disciplines. Future work should assess long-term retention and explore curriculum integration.