Difference between revisions of "Compartment pressure measurement"
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==Indications== | ==Indications== | ||
| + | {{Compartment Syndrome Indications}} | ||
==Contraindications== | ==Contraindications== | ||
| + | *Avoid areas of cellulitis. | ||
| + | *No absolute contraindications | ||
==Equipment Needed== | ==Equipment Needed== | ||
| + | *All cases | ||
| + | **Chloroprep or other skin prep solution | ||
| + | **[[Lidocaine]] 1% without epi | ||
| + | **5cc syringe | ||
| + | **22g or 25g needle with enough length to reach compartment | ||
| + | *Stryker available | ||
| + | **Stryker Intra-Compartmental Pressure Monitor | ||
| + | **Prefilled syringe with saline | ||
| + | *Arterial line transducer | ||
| + | **Intracompartment needle (simple 18-gauge needle or 18-gauge spinal needle) | ||
| + | **High-pressure tubing | ||
| + | **Pressure transducer with cable | ||
| + | **Pressure monitor/module | ||
| + | **1L NS with pressure bag | ||
| + | **Two 3-way stopcocks | ||
==Procedure== | ==Procedure== | ||
| − | # Contents of the pressure measurement kit | + | #Contents of the pressure measurement kit |
| − | # Remove contents from wrapping | + | #Remove contents from wrapping |
| − | # Attach chamber to the pre-filled saline syringe | + | #Attach chamber to the pre-filled saline syringe |
| − | # Place the aforementioned into the monitor/unit | + | #Place the aforementioned into the monitor/unit |
| − | # Place needle onto chamber | + | #Place needle onto chamber |
| − | # Eject excess air, if present, from syringe | + | #Eject excess air, if present, from syringe |
| − | # Zero the assembled unit at the angle you will be entering compartment | + | #Zero the assembled unit at the angle you will be entering compartment |
| − | # Insert, inject 2-3 drops of saline, and await measurement | + | ##Determine the appropriate [[Limb Compartments|site of injection]] to measure the desired compartment pressure |
| + | #Clean the area with alcohol prep or chlorhexidine. | ||
| + | #Insert, inject 2-3 drops of saline, and await measurement | ||
[[File:Compartment pressure striker steps.jpg|Steps to measure compartment pressure using a striker needle]] | [[File:Compartment pressure striker steps.jpg|Steps to measure compartment pressure using a striker needle]] | ||
| − | == | + | ===Technique=== |
| + | *should be performed within 5cm of fracture site | ||
| + | *anterior compartment | ||
| + | **entry point: 1 cm lateral to anterior border of tibia | ||
| + | **needle should be perpendicular to skin | ||
| + | *deep posterior compartment | ||
| + | **entry point: just posterior to the medial border of tibia | ||
| + | **advance needle perpendicular to skin towards fibula | ||
| + | *lateral compartment | ||
| + | **entry point: just anterior to the posterior border of fibula | ||
| + | *superficial posterior | ||
| + | **entry point: middle of calf | ||
| + | |||
{{Compartment Pressure Interpretation}} | {{Compartment Pressure Interpretation}} | ||
==Complications== | ==Complications== | ||
| + | *Infection | ||
| + | **Low risk | ||
| + | **Minimized by strict sterile technique | ||
| + | *Pain | ||
| + | **Minimized by local lidocaine infiltration | ||
==See Also== | ==See Also== | ||
| + | *[[Compartment Syndrome]] | ||
| + | *[[Burns]] | ||
| + | *[[Rhabdomyolysis]] | ||
| + | *[[Fractures (Main)]] | ||
==External Links== | ==External Links== | ||
| + | *[http://www.wheelessonline.com/ortho/compartment_syndrome Wheeles Textbook - Compartment Syndrome] | ||
| − | == | + | ==References== |
| − | |||
<references/> | <references/> | ||
| − | [[Category:Procedures]][[Category: | + | [[Category:Procedures]][[Category:Orthopedics]][[Category:Trauma]] |
Latest revision as of 21:28, 22 October 2019
Contents
Indications
Compartment Syndrome Indications
- Consider whenever pain or paresthesia occurs in an extremity after:
- fracture (most common risk factor) - can occur with open fracture
- crush injury
- immobilization
- snake bites
- burns
- prolonged tourniquet application
- fluid extravasation into a limb
- soft tissue infection
- extreme exertion
- Immediate threat is viability of nerve and muscle; later threat is infection, gangrene, rhabdomyolysis, renal failure
Contraindications
- Avoid areas of cellulitis.
- No absolute contraindications
Equipment Needed
- All cases
- Chloroprep or other skin prep solution
- Lidocaine 1% without epi
- 5cc syringe
- 22g or 25g needle with enough length to reach compartment
- Stryker available
- Stryker Intra-Compartmental Pressure Monitor
- Prefilled syringe with saline
- Arterial line transducer
- Intracompartment needle (simple 18-gauge needle or 18-gauge spinal needle)
- High-pressure tubing
- Pressure transducer with cable
- Pressure monitor/module
- 1L NS with pressure bag
- Two 3-way stopcocks
Procedure
- Contents of the pressure measurement kit
- Remove contents from wrapping
- Attach chamber to the pre-filled saline syringe
- Place the aforementioned into the monitor/unit
- Place needle onto chamber
- Eject excess air, if present, from syringe
- Zero the assembled unit at the angle you will be entering compartment
- Determine the appropriate site of injection to measure the desired compartment pressure
- Clean the area with alcohol prep or chlorhexidine.
- Insert, inject 2-3 drops of saline, and await measurement
Technique
- should be performed within 5cm of fracture site
- anterior compartment
- entry point: 1 cm lateral to anterior border of tibia
- needle should be perpendicular to skin
- deep posterior compartment
- entry point: just posterior to the medial border of tibia
- advance needle perpendicular to skin towards fibula
- lateral compartment
- entry point: just anterior to the posterior border of fibula
- superficial posterior
- entry point: middle of calf
Interpretation of Compartment Pressure
- Normal is <10 mm Hg
- Pressures <20 mmHg can be tolerated w/o significant damage
- Exact level of pressure elevation that causes cell death is unclear. It was previously thought pressure >30 mmHg was toxic although the "delta pressure" may be better predictor than absolute pressure
ΔPressure = [Diastolic Pressure] – [Compartment Pressure][1]
- ΔPressure < 30 mm Hg is suggestive of compartment syndrome
Complications
- Infection
- Low risk
- Minimized by strict sterile technique
- Pain
- Minimized by local lidocaine infiltration