Intraabdominal Pressure Monitoring

1.  Perform hand hygiene and don gloves.
2.  Assemble the entire pressure transducer system, flush the system with NS, and pressurize the system to 300 mm Hg, using the pressure bag.
3.  Attach the 60-ml syringe to the distal stopcock and attach the needle to the end of the tubing.
4.  Connect the pressurized system to the pressure module of the monitoring system with the transducer cable. Select a 30- or 60-mm Hg scale.
5.  Level the fluid interface (zeroing stopcock) to the symphysis pubis.
6.  Zero the intraabdominal pressure monitoring system.
7.  Clamp the bladder drainage system just distal to the catheter and drainage bag connection on the drainage bag tubing.
8.  Cleanse the sampling port on the urinary drainage system with povidone and aseptically insert the needle or angiocatheter into the sampling port. If using the angiocatheter, insert the angiocatheter and thread the catheter into the port; remove the needle and connect the catheter to the pressure tubing.
9.  Turn the stopcock attached to the syringe off to the patient and open to the pressure bag and syringe. Activate the fast-flush mechanism (pigtail) while pulling back on the syringe plunger to fill the syringe to 50 ml.
10. Turn the stopcock off to the pressure bag and open to the syringe and patient. Inject the 50 ml of saline into the bladder.
11. Expel any air seen between the clamp and the urinary catheter by opening the clamp and allowing the saline to flow back past the clamp; then reclamp.
12. Run a strip of the waveform.
13. Measure the intraabdominal pressure at end expiration tubing.
14. Once a reading has been obtained, remove the needle from the sampling port and unclamp the drainage system. If an angiocatheter has been used, it should be left in the sampling port with the entire transducer system left connected. The urinary drainage system should be left unclamped between readings.
15. Record the bladder pressure on the patient flow sheet and remember to subtract the 50 ml of instilled saline from the hourly urine output.
16. Report IAP readings per protocol, if they are trending upward or if they are associated with other assessment findings indicating the development of IAH and ACS.
17. Discard used supplies, and perform hand hygiene.
18. Document in patient record.

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