Continuous Intracompartmental Pressure Monitoring for Acute Compartment Syndrome.

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.