Minnesota Tubes Placement and Management

Last updated: February 9, 2026

The Minnesota tube is used for the management of massive upper gastrointestinal (GI) hemorrhage due to esophageal or gastric varices.

Placement and Management

1. Preparation: Check both the gastric and esophageal balloons for adequate inflation prior to insertion.
2. Insertion: Ensure the patient is intubated to protect the airway. Lubricate the tube and insert it to the 50 cm mark (hash marks are located every 5 cm). Use a video laryngoscope or esophagogastroduodenoscopy (EGD) guidance to ensure the tube enters the esophagus.
3. Confirmation: Inflate the gastric balloon with 50 mL of air. Obtain a KUB (kidney, ureters, and bladder) X-ray to confirm that the balloon is located within the stomach, distal to the gastroesophageal (GE) junction.
4. Final Inflation: Once confirmed, inflate the gastric balloon with an additional 450 mL for a total volume of 500 mL. Pull the tube back until resistance is felt at the GE junction and obtain a second KUB X-ray for final confirmation.
5. Traction: Use a 1 kg counterweight (e.g., a 1,000 mL intravenous [IV] solution bag) tied to the oral end of the tube to provide countertraction. This can be slung over an IV pole.
6. Monitoring: The Minnesota tube has four ports: two for aspiration (esophageal and gastric) and two for inflation (esophageal and gastric). Balloons should be deflated every 12 hours.

Safety Precautions

Confirm the correct location of the gastric balloon prior to full inflation, as inflation within the esophagus is often fatal. Use a sphygmomanometer to monitor pressures and avoid overinflation.

The esophageal balloon is typically not required and should never be used alone. It should only be inflated if bleeding continues despite appropriate gastric balloon placement and tension. If needed, inflate the esophageal balloon to 30 mmHg, increasing to 45 mmHg if bleeding persists.

Note: The Sengstaken-Blakemore tube requires 250 mL for total gastric balloon inflation.