Continuous Intracompartmental Pressure Monitoring for Acute Compartment Syndrome
Andrew D Duckworth1, Margaret M McQueen1
1Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth: andrew.duckworth@yahoo.co.uk.
Introduction:
We recommended that all patients at risk for acute compartment syndrome undergo continuous intracompartmental pressure monitoring.
Step 1 Patient Consent:
Provide thorough explanations so that the patient can give informed consent to undergo catheter placement and continuous compartment pressure monitoring.
Step 2 Position The Patient:
Perform the procedure with the patient supine, in either the recovery room (post anesthetic care unit) or with adequate assistance on the ward.
Step 3 Preparation:
Have all required items for the slit catheter technique for continuous intracompartmental pressure monitoring with placement under a strict aseptic technique.
Step 4 Insert The Catheter:
At the time of admission to the hospital, insert a slit catheter into the anterior compartment with the catheter tip within 5 cm of the fracture level and 1 to 2 cm lateral to the tibia.
Step 5 Attach The Transducer:
Once the catheter is in position, fill it with normal saline solution and attach it to the transducer and pressure manometry tubing, providing a continuous column of saline solution between the compartment and the transducer.
Step 6 Attach The Transducer To The Monitor And Check Reading:
Once assembly is complete, you must check that the catheter is working properly and providing accurate readings; then measure the patient's blood pressure at the initial and every subsequent reading.
Step 7 Continuous Monitoring:
Perform continuous monitoring for twenty-four hours or until the pressure is consistently dropping and the ΔP is consistently rising, whichever is the longer.
Results:
In our previously published study, we examined 850 patients who underwent continuous intracompartmental pressure monitoring following a fracture of the tibial diaphysis.
What To Watch For:
IndicationsContraindicationsPitfalls & Challenges.
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