Intra-abdominal pressure monitoring QUESTION!

[cdash724]

I work in a CVICU and don't see these that often but just had a patient today where it was ordered for q6hr IAPs via their foley catheter. I personally had never done them before and when I was getting report the night RN was explaining how to do it and said they'd been injecting AIR into the bladder. I questioned this and apparently the vascular fellow originally told the previous day RN to do this...and they did it without question. I looked up the proper procedure for this monitoring and air wasn't mentioned in any way.

My concern is what consequences does this have on the patient, if any? My thinking is that the air they were injecting (oh, 60ccs by the way rather than the 30cc of NS) could cause bladder spasms and possibly make its way to the kidneys and end up causing an air embolus somehow. With that injected air naturally rising to the top of their bladder and the foley catheter sitting on the bottom, short of tipping the patient on their head how could I ensure that the air is removed?

Does anyone have any insight into this? The patient ultimately received three, if not more, injections of 60cc of air through the catheter...His readings were 13 this am, 16 this afternoon and he'd been complaining of 'tightness' through his abdomen the whole day as well as backpain (he'd originally been transferred to us for a leaking turned ruptured aneurysm so he does have blood in his retroperotoneum & chronic back pains which he takes massive amounts of pain meds for). As of shift change, the vasc fellow had ordered for an NGT->LWS to decompress him because the patient felt as though he couldn't even take another sip of water he was so 'full'.

[Kamer BSN CCRN]

Wow, the air being injected definetly not a good thing especially if it was not being removed afterwards. It could have definetly made the interabdominal pressures worse. The NGT was to relieve pressures in the abdomen for sure, also laxative to stimulate BM if surgeon feels gut is intact to do so. there are other recommendations to decrease abdominal pressures, try a medical search engine. Head of bed should also be around 30-45 degrees with feet down. Relieving pressure on the vital organs and vessels is crucial. Make sure and educate your staff there is definetly lack of knowledge there. We went through this issue of appropriate procedure to follow also. Cudos for questioning!! That's what makes a good nurse! AACN should have a procedure recommendation that your unit should educate and follow in the future.

[Nurserton]

The most glaringly obvious thing is that this practice would further increase IAP. My experience with IAP monitors is limited but we've started to see them more in the Neuro ICU. There are specialized catheter set up kits that are meant for IAP monitoring that are not just foleys to drain urine ...with those, you do pump air into them to get a reading, but it's a specialized catheter system meant for that use with a mode of releasing the air after testing, unlike a regular Foley.

The literature shows that monitoring IAP is important in pt outcomes, so kudos to your team for that. But they might want to invest in the proper equipment to do so.