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Compartment Pressure Measurement Periprocedural Care

  • Author: Liudvikas Jagminas, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
 
Updated: May 16, 2016
 

Equipment

The equipment employed for compartment pressure monitoring includes the following:

  • Stryker Intra-Compartmental Pressure Monitor System (Stryker Surgical, Kalamazoo, MI; see the first image below)
  • Syringe, prefilled with saline
  • Side-port needle
  • Diaphragm chamber
  • Arterial line transducer system (see the second image below) - This system, used with a simple or side-port needle, provides a high degree of accuracy for simple episodic readings; the commercially available Stryker system (see the first image below) provides consistent accurate readings for episodic and extended monitoring situations; the mercury manometer system is the least accurate measurement system, is no longer available, and therefore is not described here
  • Intracompartment needle - Needles available for placement into the compartment for pressure measurement include a simple 18-gauge needle, an 18-gauge spinal needle (for deep compartments), and the side-port needle (Stryker); the side-port needle and slit catheter have comparable efficacy in this setting, whereas a simple 18-gauge needle is less precise
  • High-pressure tubing
  • Pressure transducer with cable
  • Pressure monitor/module
  • Sterile saline
  • Transducer stand that allows variable height
  • Two three-way stopcocks
  • Syringe, 20 mL
Stryker. Stryker.
Arterial line transducer. Arterial line transducer.
Next

Patient Preparation

Anesthesia

The skin should be anesthetized with a small amount of local anesthetic, with care taken to avoid injection into muscle or fascia. Excessive deep infiltration may falsely elevate the compartment pressure reading. Lidocaine 1-2% without epinephrine is sufficient to provide local anesthesia (see Local Anesthetic Agents, Infiltrative Administration).

Consider procedural sedation and analgesia in any patient who may be uncooperative and unable to hold the extremity still during the procedure. Any struggling or movement that requires restraint of the extremity may falsely elevate the compartment pressure.

Positioning

The positioning of the patient and the extremity for compartment pressure measurement depends on the extremity being studied, the compartment being studied, and the presence or absence of coexisting injury.

Patients should be comfortable, usually in the supine or prone position. The compartment to be measured should be at the same level as the heart. The patient and extremity should be positioned so that the needle can be introduced perpendicularly to the muscular compartment being measured. Remove any obstructions at the needle’s entry point into the skin, as well as all structures that may put pressure on the compartment and falsely elevate the pressure.

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Contributor Information and Disclosures
Author

Liudvikas Jagminas, MD, FACEP Associate Professor and Vice-Chair, Department of Emergency Medicine, Yale University School of Medicine; Director of Clinical Operations, Department Emergency Medicine, Yale New Haven Hospital

Liudvikas Jagminas, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Trauma Society, Rhode Island Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Joseph U Becker, MD Fellow, Global Health and International Emergency Medicine, Stanford University

Joseph U Becker, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The author, Liudvikas Jagminas, MD, would like to thank his sons, Darius and Aleksus Jagminas, for contributing the drawings and photographs.

References
  1. Matsen FA. Compartmental syndromes. Grune & Stratton; 1980.

  2. Roed C, Bayer L, Lebech AM, Poulsen JB, Katzenstein T. [Compartment syndrome following adder bites]. Ugeskr Laeger. 2009 Jan 26. 171(5):327-8. [Medline].

  3. Von Volkmann R. Verletzungen und Krankheiten der Bewegungsorgane. Hanbude der Allgemeinen und Speciellen Chirurgie. 1872.

  4. Liu HL, Wong DS. Gluteal compartment syndrome after prolonged immobilisation. Asian J Surg. 2009 Apr. 32(2):123-6. [Medline].

  5. Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment Syndrome of the Lower Leg and Foot. Clin Orthop Relat Res. 2009 May 27. [Medline].

  6. Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005 Nov. 13(7):436-44. [Medline].

  7. Badhe S, Baiju D, Elliot R, Rowles J, Calthorpe D. The 'silent' compartment syndrome. Injury. 2009 Feb. 40(2):220-2. [Medline].

  8. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975 Nov-Dec. 43-51. [Medline].

  9. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996 Jan. 78(1):95-8. [Medline].

  10. Simon RR, Koenigsknecht SJ. Emergency Orthopedics of the Extremities. 4th. New York: McGraw-Hill Publishing; 2001.

  11. Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH. Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am. 1978 Dec. 60(8):1091-5. [Medline].

  12. Hargens AR, Schmidt DA, Evans KL, et al. Quantitation of skeletal-muscle necrosis in a model compartment syndrome. J Bone Joint Surg Am. 1981 Apr. 63(4):631-6. [Medline].

  13. Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996 Mar. 40(3):342-4. [Medline].

  14. Katz LM, Nauriyal V, Nagaraj S, Finch A, Pearlstein K, Szymanowski A. Infrared imaging of trauma patients for detection of acute compartment syndrome of the leg. Crit Care Med. 2008 Jun. 36(6):1756-61. [Medline].

 
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Arterial line transducer.
Stryker.
Anterior compartment: pressure measurement.
Deep posterior compartment: pressure measurement.
Lateral compartment: pressure measurement.
Superficial posterior compartment: pressure measurement.
Algorithm for management of a patient with suspected compartment syndrome.
Compartment pressure measurement.
 
 
 
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