Authors: (including presenting author): :
CN Li (1), HK Lo (1), LT Au (1), MC Li (1), KY Wong (1)
Affiliation: :
(1)Department of Surgery, United Christian Hospital
Keyword 1: :
Massive Upper Gastrointestinal Bleeding
Keyword 2: :
High-Fidelity Simulation Training
Keyword 3: :
Sengstaken–Blakemore tube
Keyword 5: :
Communication
Introduction: :
Massive UGIB from esophageal varices is a time-critical surgical emergency with high morbidity and mortality, demanding rapid and coordinated interventions. Bevano VII consensus and European Society of Gastrointestinal Endoscopy cascade guideline suggested managing acute variceal bleeding required prompt volume resuscitation, transfusion to restore hemodynamic stability and balloon tamponade (Sengstaken–Blakemore tube) with intensive care monitoring, as an enhanced level measure for refractory bleeding. However, A Sengstaken–Blakemore tube is intended only as a temporary bridge intervention, due to the need for careful handling and close monitoring. To optimize frontline preparedness, a simulation-based training is implemented to strengthen frontline nurses crisis recognition, management, procedural competence and team communication.
Objectives: :
1) Reinforce indications/contraindications and stepwise preparation for Sengstaken–Blakemore tube insertion 2) Improve early detection of deterioration and appropriate nursing actions; 3) Strengthen ISBAR communication, multidisciplinary teamwork, and documentation 4) Evaluate learning gains and readiness of nurses
Methodology: :
A single-centre, high-fidelity simulation training was conducted on 22 Jan 2025 for nurses of all ranks and clinical experience in Surgical Department. The instructional framework is based on Kolb’s Experiential Learning Cycle augmented by Peyton’s 4-step for procedural skills. Participants engaged in a scenario of a case of a massive UGIB with hypovolemic shock, airway compromise, and need for Sengstaken–Blakemore tube and ICU transfer. The knowledge level, achievement of learning outcomes and satisfactory level of the training was evaluated with multiple choice questions, 6-point Likert scale questions and structured open-ended questions.
Result & Outcome: :
A total of 24 nurses participated in the training and 15 nurses completed the evaluation component. For the primary learning outcome, knowledge level shows a remarkable improvement from the median pre-test score = 25/100 to 100/100, indicating a substantial enhancement in understanding and handling of the Sengstaken–Blakemore tube. For secondary learning outcome, participants reported 1) improved procedural competence in the preparation and insertion of the Sengstaken–Blakemore tube, 2) enhanced team communication, particularly the structured use of ISBAR, and 3) more effective teamwork strategies and clearer role delineation during crisis management. The simulation-based training significantly improved nurses’ competency in managing esophageal variceal bleeding related massive UGIB, particularly in the use of Sengstaken–Blakemore tube. It also strengthened crisis resource management, team communication, and adherence to evidence-based guidelines. Overall, the programme contributed to reinforcing institutional preparedness and promoting safer, more coordinated emergency care for patients with life-threatening UGIB.
