Intra-abdominal Pressure Monitoring.
nursebob

September 10, 2005

OUTCOMES : The identification of intra-abdominal hypertension, in the clinical setting of a tense abdomen and oliguria, will enable appropriate intervention to be taken. The pathophysiological effects of raised intra-abdominal pressure include: reduced cardiac output; increased renal and systemic vascular resistance; decreased venous return; impaired visceral blood flow and altered
respiratory dynamics.


EQUIPMENT : - Foley urethral catheter (refer to the Policy / Procedure : Insertion of A Urethral Catheter if catheter not in place)
- Sterile gloves; -basic dressing pack; -antiseptic solution;
- 16 g. intravenous cannula;
- 10 cm. length three-way stopcock;
- disposable pressure monitoring kit (cat. no. 10); -pressure cable and module;
- 500 ml intravenous flask; - pressure bag;
- Luer-lock macrodrip intravenous giving set; -100 ml flask 0.9% Sodium Chloride;
- rubber- tipped forceps; adhesive tape;
- pressure transducer holder; - intravenous pole.

PROCEDURE :
-
Position patient supine.
- Connect pressure monitoring equipment to three-way stopcock.
- Place pressure transducer in holder.
- Position intravenous pole to side of patient, at the level of the hips.
- Adjust height of the pressure transducer, so that the atmospheric port is level with the top of the symphysis pubis.
- Connect saline and giving set to three-way stopcock.
- Clamp urinary drainage bag, immediately below aspiration port.
- Don gloves and clean aspiration port.
- Cannulate aspiration port of urinary drainage bag.
- Remove cannula stylet and connect intravenous cannula to Luer end of three-way stopcock.
- Tape cannula and three-way stopcock to urinary drainage bag.
- Calibrate pressure transducer.
- Infuse 100ml saline into the bladder. - Store end-expiratory intra-abdominal pressure reading.
-
Release clamp.
- Deduct 100ml from hourly urine output.
- Document reading on flowchart.
- Repeat procedure every eight hours and as required.

ALERT
Intra-abdominal hypertension has been defined as a pressure reading greater than 20 mmHg.
References:

Civetta, JM; Taylor, RW.; Kirby, RR 1992. Critical Care (Second Edition). J.B.Lippincott Company. Philadelphia.
Sugrue, M.; Buist, MD.; Hourihan, F.; Deane, S.; Bauman, A.; Hillman,K. 1995. Prospective study of intra-abdominal hypertension and renal function after laparotomy. British Journal of Surgery. 82. pp. 235-238