Essential Surgical Techniques
Continuous Intracompartmental Pressure Monitoring for Acute Compartment Syndrome
Andrew D. Duckworth, MSc, MRCSEd; Margaret M. McQueen, MD, FRCSEd(Orth)

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

Introduction

We recommend that all patients at risk for acute compartment syndrome undergo continuous intracompartmental pressure monitoring.

A permutation of clinical signs and/or intracompartmental pressure monitoring is …


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