FUNG GROUPIDS Medical Systems IndonesiaINTRA ABDOMINAL PRESSUREMONITORINGDeya PrastikaProduct Specialist MS

ABVISER

Definition of TermsIntra-abdominal Pressure (IAP): is the pressure within the abdominal cavity. Normal IAP is 1 - 8 mmHg.

Intra-abdominal hypertension (IAH): is defined as an IAP greater than 12mmHg.

Abdominal compartment syndrome (ACS): is defined as an IAP >20mmHg and the onset of new organ failure.

Risk factorsDiminished abdominal wall compliance Major trauma & burns; acute respiratory failure; abdominal surgery Increased intra-luminal contents Gastropareisis; ileus; pseudo obstruction Increased abdominal contents Ascites/liver dysfunction;Haemoperitioneum/pneumoperitoneum; Capillary leak/fluid resuscitation Acidosis (pH

Effect

Procedure for IAP monitoring

EquipmentrequiredFoleyurine catheter of appropriate size Urine bag for drainage of urine 2 x 3 way tap Connector (leur lock to catheter tip) Pressure transducer and tubing 50ml leur lock syringe 10ml or 30ml leur lock syringe Sterile 0.9% sodium chloride Clamp

Measurement ofIAPVideo avalable on youtube : http://www.youtube.com/watch?v=hUU5Yy2iEPM

Special Considerations0.9% Sodium Chloride should only beusedto fillthe patient's bladder when undertaking an intra abdominal pressure measurement. The tubing must be free of kinks and air bubbles. All transducer monitoring lines should be clearly labeled Transducer sets should bechanged every 72 hours. All connections should be securely luer locked. All interventions must be carried out using an aseptic technique

ComplicationsInfection of the bladder is a complication of this procedure. Symptoms vary depending on the age of the child but include:Fever Vomiting General malaise Frequency Local pain Dysuria

ReferencesCheatham M, Malbrain M, Kirkpatric A, Sugrue M, Parr M et al (2007). Results from the international conference of experts on intr-aabdominal hypertension and abdominal compartment syndrome. II Recommendations. Intensive Care Medicine. 33:951-962. Davis P, Koottayi S, Taylor A, Butt W. (2005) Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Medicine. 31:471-475 Ejike J, Bahjri K, Mathur M. (2008). What is the normal intra-abdominal pressure in critically ill children and how should we measure it? Critical Care Medicine. 36(7):2157-2162 Ejike J, Kadry J, Bahjri K, Mathur M. (2010). Semi recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children. Gallagher JJ (2000) Ask the Experts Critical Care Nurse, 20, 1 p:87. Iberti TJ, Lieber CE, Benjamin E. (1989) Determination on intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology, 70 (1): 47-50 LCP Rao, CR Chaudhry, LCS Kumar ( 2006) Abdominal Compartment Pressure Monitoring - a simple techniques. MJAFI,Vol. 62, No. 3. Moore A,Hargest R, Martin M,Delicata R.J, (2004) Intra-abdominal hypertension and the abdominal compartment syndrome. British Journal of Surgery, 91: 1102-10 Ravishankar N, Hunter J (2005) Measurement of Intra-abdominal hypertension in intensive care units in the United Kingdom. British Journal of Anaesthesia Volume 94, Number 6 Pp. 763-766. Sugrue M, Intra-abdominal pressure: time for clinical practice guidelines?. Intensive Care Med 28: 389-91. Balough Z, Jones B, Amours S, Parr M and Sugrue M Continuous intra-abdominal pressure measurement technique. The American Journal of Surgery Volume 188(6):679-684

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