Continuous Intracompartmental Pressure Monitoring for Acute Compartment Syndrome

Abstract

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.

Figures

Fig. 1

A fourteen-gauge central venous slit catheter and trocar.

Fig. 2

Preparation of the slit catheter, with longitudinal slits made in the end to give it a “castellated” appearance.

Fig. 3

Estimation of the entry point (arrow) on the anteroposterior radiograph of a midshaft tibial diaphyseal fracture. The entry point should be proximal to the fracture site and 1 to 2 cm lateral to the lateral subcutaneous border of the tibia.

Fig. 4

Confirmation of slit catheter placement with use of dye, with the tip within 5 cm of the fracture level.