Intra-Abdominal Pressure Monitoring
Intra-abdominal pressure monitoring measures the pressure in the abdominal compartment. It can be assessed indirectly in the patient with an indwelling urinary catheter by measuring the pressure in the bladder with a needle that connects a pressure transducer to the urinary catheter or by inserting an IV catheter into the sampling port. Pressure in the abdomen may rise from such conditions as intraperitoneal bleeding, third-space fluid resuscitation, peritonitis, ascites, gaseous bowel distention, abdominal surgery, and trauma.
If pressure in the abdominal cavity becomes greater than the pressure in the capillaries that perfuse the abdominal organs, ischemia and infarction may result. Increased intra-abdominal pressure can also lead to reduced cardiac output, increased systemic vascular resistance, increased vascular resistance, and reduced venous return. By measuring intra-abdominal pressure, the nurse can detect a rise in pressure and initiate lifesaving measures.1
Equipment
Indwelling urinary catheter with drainage bag ▪ gloves ▪ cardiac monitor ▪ pressure cable for monitor interface ▪ 500- or 1,000-mL bag of IV normal saline solution ▪ appropriate-size pressure bag ▪ IV tubing ▪ pressure tubing, pressure transducer with flush device, and two stopcocks ▪ 30-mL luer-lock syringe ▪ clamp ▪ antiseptic cleaning solution ▪ tape ▪ IV pole.
Several commercially prepared kits are available. Examples include the Bard and AbViser intra-abdominal pressure monitoring systems.
Preparation of Equipment
Before setting up the monitoring system, perform hand hygiene.4,5,6 Maintain asepsis throughout preparation and wear the appropriate personal protective equipment. (For instructions on setting up and priming the monitoring system, see “Transducer system setup,” page 739.)
Verify the doctor’s order. Assemble the equipment, taking care not to contaminate dead-end caps, stopcocks, and syringes.
Connect the IV tubing to the transducer, the transducer to two successive stopcocks, and then the second stopcock to the pressure tubing and monitor cable. Attach a 30-mL syringe to the side port of the first stopcock. Place the transducer in the transducer holder attached to the IV pole. Hang the 500-mL bag of normal saline solution from an IV pole, attach the IV tubing, and flush the entire line system of air. Use the pressure bag to pressurize the system to 300 mm Hg. Attach the cable from the transducer to the monitor and select a 30 mm Hg scale for monitoring pressure.
Connect the IV tubing to the transducer, the transducer to two successive stopcocks, and then the second stopcock to the pressure tubing and monitor cable. Attach a 30-mL syringe to the side port of the first stopcock. Place the transducer in the transducer holder attached to the IV pole. Hang the 500-mL bag of normal saline solution from an IV pole, attach the IV tubing, and flush the entire line system of air. Use the pressure bag to pressurize the system to 300 mm Hg. Attach the cable from the transducer to the monitor and select a 30 mm Hg scale for monitoring pressure.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
Explain the procedure to the patient, including the purpose of intra-abdominal pressure monitoring and anticipated duration of catheter placement, to reduce anxiety and enhance cooperation.
Insert an indwelling urinary catheter, if the patient doesn’t already have one in place. (See “Indwelling urinary catheter care and removal,” page 374.)
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