Bougie facilitated Minnesota tube placement for control of massive gastrointestinal hemorrhage

Placement of a Minnesota tube is a rare but potentially life saving procedure used to control massive gastroesophageal (GI) hemorrhage but placement can be complicated by coiling or other difficulties advancing the tube into adequate position and rescue techniques are not always successful.

This article discusses the use of a bougie to facilitate placement of a Minnesota tube in a case of life threatening GI hemorrhage.

A 34 year old woman was brought by emergency medical services to our emergency department with return of circulation after prolonged out of hospital cardiac arrest and found to have life threatening gastrointestinal hemorrhage. Placement of a Minnesota tube in typical blind fashion was unsuccessful and could not be successfully placed despite the use of traditional adjunctive techniques such as optimizing positioning, stiffening the tube in cold water and the use of laryngoscopy with Magill forceps. The Minnesota tube was ultimately successfully placed by placing a bougie into the distal eyelet to guide it into the stomach. The patient was subsequently stabilized and taken for definitive intervention.

Difficult placement of a Minnesota tube may be addressed by placing the coudé tip of a bougie into the distal eyelet and advancing the devices in tandem into proper position. This may be associated with less risk of trauma than the use of stiffened wires as previously described.