Cara mengukur tekanan intrakompartemen

Explain the risks and benefits of the procedure to the patient and/or their representative.

Discuss the low risk of bleeding, low risk of infection, and the possibility of obtaining erroneous values.

Obtain a written informed consent from the patient and/or their representative if possible.

Proceed after documentation of the medical necessity if the patient is unable to consent and no
representative is available.

When performing the procedure on a neonate or child, it is advisable to give the parent the option to
leave the room or look away as the procedure can be disconcerting to some parents.

 Wash away any blood, dirt, or debris on the patient’s skin.

 Identify the landmarks for needle insertion and mark the skin puncture sites.
 Apply povidone iodine or chlorhexidine solution to the skin around the puncture sites and
allow this to dry. The measurement of compartment pressures is considered a sterile
procedure, and the EP should don a hat, mask, sterile gloves, and a sterile gown. Create a
sterile field with surgical towels or drapes.
 Reidentify the landmarks for needle insertion and ensure the skin puncture sites are still
marked.
 The exact locations at which to measure the intracompartmental pressures are not clearly
defined. There were no clearly established guidelines for determining the appropriate location
 for compartmental pressure measurements in patients with fractures prior to the study of
Heckman and Whitesides.
 The results of their study suggest that measurements be performed at the level of the fracture
“as well as locations proximal and distal to the zone of the fracture.” A 5 cm distance was used
from the fracture site to the proximal and distal needle insertion sites.
 Insert the needle at the point of maximal tightness of the compartment in the absence of a
fracture and at least two other sites within the compartment.

General anatomic landmarks for needle insertion into the various compartments of the lower leg and
forearm are described in Tables 93-2 and 93-3 and graphically depicted in Figure 93-3.

The authors recommend using the highest measured intracompartmental pressure in making the
decision for further intervention.

TEKNIK

Several techniques for measuring compartmental pressures have been developed.

Some use isolated intracompartmental pressure measurements while others monitor pressure
continuously.

Obtaining isolated intracompartmental pressure measurements is most important in the ED.

 The needle manometer method uses a manual manometer and a saline-air meniscus in
standard IV tubing connected to a 16 gauge needle.
 Stryker (Stryker Instruments, Kalamazoo, MI) introduced an electronic system consisting of a
reusable digital pressure monitor and a single-use measurement set with a needle, diaphragm
chamber, and sterile saline flush.4
 (Arterial manometer technique) A technique involving a 16 gauge angiocatheter or needle
connected by arterial line tubing to a standard manometer has been described.4

All three of these methods will be discussed in this chapter. Data suggest that the Stryker method and
the arterial manometer method are significantly more accurate, are more convenient, and require
only a small number of components readily available in most EDs when compared to the needle
manometer method.50,51 Each of these techniques may be performed with a standard straight needle.
All are more accurate if used with a special sideported needle or slit catheter, if available.51 Similar
measurement systems that introduce a wick or slit catheter into the tissue have been shown to be
equally effective. Explanations of the wick and catheter techniques have been omitted as they are rarely
performed in the ED.