[janfrn]

I haven't started a thread in a long time! Here goes!!!

Are any of you currently doing bladder pressure measurements to assess for abdominal compartment syndrome? Would you share your method and parameters with me?

The other night I was caring for a 15 kg child POD 2 liver retransplant who became anuric early in the shift. Girth was rising and the abdomen was quite tense. I had a continuous FFP infusion running in the CVP, but whenever I checked it the CVP was always normal. (Some question there since there was a series of t-pieces with soft tubing between the transducer tubing and the kid, and it was a tunnelled CVC.) Vent pressures hadn't really changed, gases were improving, LFTs improving, BUN and creatinine only slightly elevated, art pressures relatively stable on 5 of dop. Fluid balance hit +1.3 L by 0300, so the surgeon (an "adult" man) was called. He wanted us to do a bladder pressure, but we don't do those. So the resident got a procedure from the adult ICU across the hall that uses an angiocath and transducer set-up. He followed the instructions, did it twice and got two wildly different numbers, which really didn't mean much because we were using "adult" parameters. So we did an ultrasound, and the kiddie ended up going to the OR at change of shift for exploration.

If I'm ever in this spot again, I'd like some pediatric references to go with. Thanks.

[AliRae]

I was just digging in old threads, and found your post, jan. Funny, because I had almost the same issue a couple months ago. Considering this post was from a couple years ago, I'm hoping you got an answer by now. If not, BUMP! Anyone out there who can help us?

The method we ended up using involved a clamped foley, a-line/transducer setup, and an 18-gague needle, if I remember correctly. We got the same number both times we did it, and the number, according to the resident, was way above where the kid should already be in the OR. She never went, but miraculously didn't end up infarcting her gut. I wish I could remember more precisely it was we did, but I don't usually work nights, and it was around 3 AM when all of that happened. =)

[janfrn]

We ended up finding a P&P from the adult side that we incorporated into our unit specific manual, but we really don't do them often enough for anyone to feel good about it! We usually go by the tried-and-true clinical assessment and subjective "I-think-we-should-consider-abdominal-compartment-syndrome" approach. We haven't had an infarcted bowel in some time, so it must be working.

[AliRae]

So you're using an adult P&P, or did you change it to make it peds specific? I think we used an adult one, but I'd love to see a peds one out there.

[janfrn]

Yeah, we're using the adult P&P. I think we've only actually measured bladder pressures maybe three times since I posted. I read an article in a journal about abdominal compartment syndrome... I'll see if I can find it.

[AliRae]

Thanks! Yeah, we don't see it too often either, but it would be nice to have a little more peds specific info.

[pedseducator]

We use what AliRae discribed. We hook up the transducer to the port where urine specimens are obtained, close to the connection where the foley meets the drainage tubing. Our normal is <20. Hope this helps.

[Clg03280]

Our unit is a SICU/PICU. We use the AACN procedure manual with a smaller volume of fluid.
Usually your patient has hemodynamic instability, increase in abdominal size and firmness, increase in vent support and decrease in u/o.
You should inject your fluid slowly and give it a couple of minutes clamped in the bladder. The patient must always be laying flat on their back. You will get different numbers each time but they should be close to each other (say within 10 points either way).
Our surgeons would take to the OR if all the above things were wrong and the pressure was greater than 25 (this number varies a little between adult and pediatric surgeons).
There is a new product on the market, the AbVisor. It is a bladder pressure measuring kit. It costs

[Clg03280]

Our unit is a SICU/PICU. We use the AACN procedure manual with a smaller volume of fluid.
Usually your patient has hemodynamic instability, increase in abdominal size and firmness, increase in vent support and decrease in u/o.
You should inject your fluid slowly and give it a couple of minutes clamped in the bladder. The patient must always be laying flat on their back. You will get different numbers each time but they should be close to each other (say within 10 points either way).
Our surgeons would take to the OR if all the above things were wrong and the pressure was greater than 25 (this number varies a little between adult and pediatric surgeons).
There is a new product on the market, the AbVisor. It is a bladder pressure measuring kit. It costs around $100.00. It

[Clg03280]

Our unit is a SICU/PICU. We use the AACN procedure manual with a smaller volume of fluid.
Usually your patient has hemodynamic instability, increase in abdominal size and firmness, increase in vent support and decrease in u/o.
You should inject your fluid slowly and give it a couple of minutes clamped in the bladder. The patient must always be laying flat on their back. You will get different numbers each time but they should be close to each other (say within 10 points either way).
Our surgeons would take to the OR if all the above things were wrong and the pressure was greater than 25 (this number varies a little between adult and pediatric surgeons).
There is a new product on the market, the AbVisor. It is a bladder pressure measuring kit. It costs around $100.00. It comes