Bakri Balloon Placement Periprocedural Care

Updated: Jul 05, 2016
  • Author: Gabor C Mezei, MD, PhD; Chief Editor: Carl V Smith, MD  more...
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Periprocedural Care

Patient Education & Consent

Elements of informed consent

Given that PPH is a true medical emergency, informed consent is not a required part of management. However, if the patient is alert and able to communicate, an attempt of a quick verbal consent should be made.

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Pre-Procedure Planning

Prior to the procedure, a bedside ultrasound of the uterine cavity should be conducted to rule out retained product of conception and to assess the angulation and shape of the uterine cavity to guide balloon catheter placement.

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Equipment

The Bakri balloon or Bakri Postpartum Device [7] is a 100% silicone construction, dual channel balloon catheter specifically designed and approved by FDA for intrauterine placement in cases of PPH. The Bakri balloon contains no latex, and therefore can be safely used in patients with latex allergies. Its time-saving catheter is easy to place and monitor and rapidly achieves tamponade within the uterine cavity.

Compared to other similar devices, the Bakri balloon has a relatively large-bore drainage channel that allows for drainage in case of fibrin formation as well. It Includes a 60-mL syringe, intended for one-time use. The manufacturer-recommended volume is 500 mL; the length of catheter shaft is 43.5 cm, and the length of drainage tip is 3.6 cm. It does not contain insufflation valves. The catheter diameter is 24-F (8 mm). [7]

The Bakri balloon remains a successful method for postpartum hemorrhage management. Recent reports have confirmed previous study findings. [12, 13, 14, 15]

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Patient Preparation

Anesthesia

Intrauterine balloon tamponade may cause significant pain for the patient and, consequently, adequate analgesia is an important consideration. Although a strong epidural may address the initial hours of pain control in patients who undergo cesarean section or vaginal delivery, providing additional pain relief while the catheter is in place may be necessary later. The pain can be alleviated by reducing the insufflated balloon slightly. However, a balance must be achieved with respect to the tamponade effect and analgesia requirements.

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Monitoring & Follow-up

As stated in the device instructional booklet, patient monitoring is an integral part of managing PPH. Signs of a deteriorating or nonimproving condition should lead to a more aggressive treatment and management of patient uterine bleeding.

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Rate of Deflation

Manufacturers' package inserts state that the maximum in-dwelling time is 24 hours or less due to concerns about infection and tissue necrosis, but this time interval was not based on any data. The balloon is then deflated, either all at once or gradually over several hours, while monitoring the patient for recurrent bleeding. Emergency surgical services and experienced staff should be readily available when the balloon is deflated in case of recurrent hemorrhage.

If bleeding recurs during deflation or after removal, reinflation or reinsertion of the balloon should not be considered. Persistent or recurrent bleeding is an indication to proceed with other treatment options.

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