Intrauterine Balloon Tamponade
Commercially available intrauterine balloon tamponade devices are available in the United States and other developed countries . It effectively stops hemorrhage in 77.5-88.8% of cases, but the cost of these manufactured balloons are in the range of $250 USD and is often unavailable in developing countries. A cheaper alternative to these devices is the condom balloon. It is made from a condom, a Foley catheter, string or spare suture, and sterile water or saline. The total cost of the device is less than 5 USD. In GO MOMS simulations, residents practice making and inserting condom tamponade balloons in neoprene vaginal models.
Materials
Balloon:
Condom
Foley catheter, any size
Piece of spare suture or string
Sterile water or saline
60cc syringe, or similar
Hemostat or small clamp
Uterus
Wash mitt uterus from B-Lynch simulation if available
Preparations
Fill the Foley catheter tip balloon bulb with 5-10cc of water.
To secure the condom over the end of the Foley, open the condom and fit the condom over the end of the Foley.
Secure the condom in place by firmly tying with a piece of suture or string. The string must be tied tight enough to stop water from leaking out of the condom, but not so tight that water cannot be pushed up through the Foley.
Through the urine drainage port, fill the condom with an initial 60cc of water to test for leaking.
Instructions For using the condom tamponade
Introduce the condom balloon catheter into the uterus
Inflate the condom through the urine drainage port using water or saline
250-500cc water as needed to fill uterine cavity and bleeding stops
Assess with bimanual exam
Use the hemostat to clamp off the catheter between fillings
Document the amount of fluid used in order to later confirm complete drainage before removing. Remove the balloon tamponade in maximum 24 - 48 hours (can remove before 24 hours if the patient is stable)
Keep hand in vagina to make sure the balloon tamponade stays inside the uterus
Then pack the vagina with moistened vaginal packing or gauze to keep the balloon tamponade in place. Be sure to count the number of gauze to assure complete removal later
Mark the top of the fundus and check frequently to assure the mark is not rising as an indication that blood is collecting in the uterus
Balloon tamponade is primarily used for bleeding post-vaginal delivery, but it can also can be used for post-operative delivery. Place the balloon into the uterine cavity prior to closing the uterine incision and guide the other end of the catheter through the cervical opening into the vagina and out. Close the uterine incision in the usual fashion but be extremely careful not to incorporate the condom as it is non-absorbable. Inflate the balloon and check for vaginal bleeding.