BACKGROUND
A low-cost and simple technique for estimating the intra-abdominal pressure (IAP) indirectly by vesical pressure measurement is described.
TECHNIQUE
Using a Foley catheter (16-F or 18-F), an intravenous infusion set, a 50 ml syringe, a measuring scale and a hemostat, provides a low-cost assessment of the IAP. The connector of the intravenous infusion set is detached from the infusion tubing and is connected to a syringe filled with 50 ml of saline. This is then connected to the main drainage channel of the Foley catheter, and saline is instilled into the empty bladder. The connector is then clamped using a rubber-shod hemostat. The empty syringe is then removed leaving behind the connector attached to the Foley catheter. The intravenous set tubing is next connected to the connector and held vertically above the symphysis. Once the hemostat is released, the saline flows out of the catheter drainage tubing and reaches a height (in cm of saline) corresponding to the IAP (Fig. 1).
Figure 1.
Intravenous infusion set tubing used as a saline column manometer
DISCUSSION
Popular techniques of measuring the IAP require a three-way connector stopcock and a manometer or pressure transducer1 and have a reported risk of sustaining needle-stick injury.2,3 Another technique uses the patient's own urine and the urinary drainage bag tubing as a fluid column manometer.4 However, accumulation of 50 ml urine in the urinary drainage bag tubing is time consuming, inaccurate and interferes with monitoring of the urine output especially in oliguric patients with increased IAP.4 Our technique allows a low-cost and simple estimation of IAP that can be repeated, but does not interfere with urine output monitoring.
References
- 1.Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauala A, Burch JM. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174:667–72. doi: 10.1016/s0002-9610(97)00201-8. [DOI] [PubMed] [Google Scholar]
- 2.Cheatham ML, Safesak K. Intra-abdominal pressure: a revised method for measurement. J Am Coll Surg. 1998;186:594–5. doi: 10.1016/s1072-7515(98)00122-7. [DOI] [PubMed] [Google Scholar]
- 3.Balogh Z, Jones F D', Amours S, Parr M, Sugrue M. Continuous intra-abdominal pressure measurement technique. Am J Surg. 2004;188:679–84. doi: 10.1016/j.amjsurg.2004.08.052. [DOI] [PubMed] [Google Scholar]
- 4.Sedrak M, Major K, Wilson M. Simple fluid-column manometry to monitor for the development of abdominal compartment syndrome. Contemp Surg. 2002;58:227–9. [Google Scholar]