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Intracompartmental Pressure Monitor
Aka: Intracompartmental Pressure Monitor, Compartment Pressure Study
- Indications
- Compartment Syndrome
- Exertional Compartment Syndrome
- Equipment
- Needles (18 gauge)
- Side-ported needle or
- Indwelling slit catheter or wick catheter
- Indicated for continuous pressure monitoring
- Consider in patients trending toward fasciotomy or those unable to communicate
- Avoid simple needle (lower accuracy)
- Hand-held monitor
- Compartment Pressure Monitor (e.g. Stryker Instrument)
- Technique
- Fluid filled 18 gauge needle inserted perpendicularly into compartment
- Infuse Normal Saline in small volume (0.1 to 0.3 ml)
- Obtain measurement for each compartment of concern
- Check pressure at level of Fracture
- Obtain all measurements with either patient supine or prone
- Lower leg
- Check pressure at proximal to middle third of lower leg (unless Fracture dictates site)
- Patient supine for all compartment measurements except the superficial posterior compartment
- Check anterior and deep posterior compartment pressures at minimum
- Anterior Compartment: 1 cm lateral to anterior tibia and 2 cm insertion depth
- Deep Posterior Compartment: Posterior to tibia from medial approach to 3 cm depth
- Ideally, check the other 2 lower extremity compartment pressures
- Lateral Compartment: Needle perpendicular to posterior aspect of fibula
- Superficial Posterior Compartment: Patient prone, needle to either side of midline
- Repeat measurement at up to every 1-2 hours as needed
- Precautions
- Avoid excess fluid infusion (raises compartment pressure, False Positive)
- Control needle depth and insertion site
- Control extremity position during measurement
- Interpretation
- Normal compartment pressure <10 mmHg
- Traumatic Compartment Syndrome Criteria
- Tissue pressure exceeds >30 mmHg (fasciotomy for pressure >30-45 mmHg)
- Delta Pressure (Diastolic pressure - Tissue pressure) <30 mmHg
- Exertional Compartment Syndrome Criteria
- Readings only valid if Exercise reproduces symptoms
- Resting tissue pressure exceeds 10 to 15 mmHg
- Pressure 5 minutes post-Exercise over 15 to 25 mmHg
- References
- Blythe, Gray and Delasobera (2018) Crit Dec Emerg Med 32(7):3-9