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Scientific Articles   |    
Continuous Intracompartmental Pressure Monitoring for Acute Compartment Syndrome
Andrew D. Duckworth, MSc, MRCSEd1; Margaret M. McQueen, MD, FRCSEd(Orth)1
1 Edinburgh 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
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Based on an original article: J Bone Joint Surg Am. 2013 Apr 17;95(8):673-7.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Jul 10;3(3):e13 1-7. doi: 10.2106/JBJS.ST.M.00023
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Extract

Overview
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

Indications

Contraindications

Pitfalls & Challenges

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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