Intra-Abdominal Pressure Monitoring

[NeosynephRN]

We were just starting to do this in the hospital I recently left. I was wondering if anyone does this routinely, and if so what do you think of it?

[cardiacRN2006, ADN, RN]

We don't do it routinely, but when it's indicated.

[seanpdent, ADN, BSN, MSN, APRN, NP]

Ditto.. not a routine thing, but we do use it often when applicable.

[juraviel]

I noticed while I was traveling that its much more common at teaching hopitals then anywhere else.

[Pedi-Gree, BSN, RN]

I wish we did it more often in our hospital. I've often wondered how many bowel perforations could have been prevented if we'd been a little more suspicious.

I saw a device that makes monitoring IAP really easy. It connects to the foley and has a scale printed on it. You zero it to the symphysis and hold it up vertically from your reference point. The column of fluid will give an appoximation of IAP based on how high it goes in the tubing. It was pretty neat. But I don't remember what it's called or who makes it. I'll see if I can find the information I brought home.

[JeffTheRN]

We see many GI post ops in our unit and occasionally will see an IAP ordered. Our's is like stated above, except we monitor in the bedside monitor and zero everything out basically like a CVP measurement.

[elizabells, BSN, RN]

I've only done it once, on a post-op diaphragmatic hernia who developed abdominal compartment syndrome. We dropped a sump tube, hooked it up to a peripheral art line setup, and ran NS through it.

[sockov, ADN, ASN, BSN, CNA, LVN]

I do it when I suspect abdominal compartment syndrome. PIPS in the 50s on the vent, low urine output, high lactate levels. Etc.

I just use supplies routinely found in the ICU.

Pressure bag, pressure tubing, 60cc luer-lock syringe, pressure cable, 500cc bag normal saline, and kelly-clamp.

Set up like you would do for an A-line. Change the name on the monitor for UAP, or UVP, or something like that. IF you don't have that option, (which I doubt now a days) then just use the ICP mode.

Set your scale to 0-60. Zero the line and the pubis area. Clamp the foley just below the injection port. Fill the syringe up to 50cc or normal saline. Turn the stopcock off towards transducer. Gently and slowly instill the 50cc NS. Re-turn the stopcock off towards syringe. Wait about 30 seconds for the transducer to get the appropriate reading. Make a strip and chart it.

If the pressure is over 25, it is a medical emergency!

We don't use any commercial product to measure this. You can use what you use for

a-line set up. REMEMBER..... DO NOT USE A HEPARIN SOLUTION MIX in the flush bag. Just use normal saline.

Hope this helps.

[Pedi-Gree, BSN, RN]

The foley adapter is much simpler to use!

[bethem]

We do it when indicated; we have a set of criteria for indicating IAP monitoring. Every trauma gets it, some abdo surgeries and some other stuff that I can't remember - it doesn't happen all that often. I had a guy with a nasty intra-abdominal sepsis the other night, and the medicos declined IAP monitoring.

I dunno, I'm still pretty new to ICU (6 months in). Anyway, we have our own jerry-rigged kits with a transducer, sterile tubing, a connector, 500mL NS, 50ml syringe, and a three-way tap. Sounds pretty similar to the one mentioned earlier. There are commercial kits available, but they are quite expensive, so we make our own.

[pamicurn]

We just got a device for measuring IAP that is simple to use called the abvisor. For years we struggled with getting measurements by rigging a system, usually after the patient was in trouble, and the doctors didn't believe them half of the time. I am hoping that with this product we will start measuring earlier. At NTI this year there was a great general session on abdominal hypertension and I think that after fluid resuscitation many of our patients show the signs that the presentor talked about. We should be catching this earlier and a good product to standardize I am hopeful will be the first step.

[NotReady4PrimeTime, RN]

Please post some feedback on how useful and easy to use this system is and how much money it saves your unit so that I can lobby for us to get it too!! We do IAP measurements so infrequently that most of our staff have no idea how to do it. We might only do one measurement on one patient and then discard the transducer, the tubing and all the connectors that are used. This has got to be not only more accurate but cheaper!