Download AbViser-Instructions-Chart

Transducer not included
Instructions
(Catalog #s ABV300, ABV301 and ABV601)
3
Caution: Prior to use, read complete instructions inside carton.
1
2
Spike saline bag (Do not use a pressurized bag).
2a
Attach your hospital transducer and cap end.
2a
You may use any transducer, but some transducers have
extra tubing and stopcocks, etc. that should be removed prior to attaching to AbViser.
1
2b
If your transducer is permanently attached to a stopcock 2
and flush device, remove the AbViser stopcock and install the transducer assembly with the transducer’s stopcock in place of the removed stopcock. Cap the flush device end.
3
Prime system by flushing saline through tubing and transducer.
4
Place sterile drape under patient’s Foley/drain bag connection.
Clamp Foley to prevent urine leakage. Prep Foley/drain bag
connection with antiseptic solution, then disconnect using
aseptic technique. Tear perforation on AbViser AutoValve protective bag. Attach Foley and drain bag connection to AbViser
AutoValve. Un-clamp Foley. Apply blue tape (included) at AbViser
AutoValve/Foley connection to prevent inadvertent disconnection
during infusion.
5
2b
7
To Saline Bag
Mount transducer to patient or pole at the level of the iliac
crest in the mid-axillary line (level of the urinary bladder). Plug
cable into AbViser IAP monitor or any ICU monitor that can display CVP or other single pressure channel.
5
Transducer Location
6
Mid-Axillary Line
Iliac Crest
6
Zero transducer by turning stopcock “off” to patient. Vent stopcock cap and push the “zero” button on the monitor. Retighten
stopcock cap and turn handle back so that the transducer is
open to the patient.
7 Be sure patient is in the supine position before measuring their
IAP. Retract the plunger until 20 mL (for adult patients) of fluid
is in the syringe. Compress the syringe plunger within 10 seconds infusing the fluid into the bladder.
Pediatric Patients: Briskly infuse 1 mL/Kg + 2 mL, not to
exceed 20 mL.1-4
8
9
Allow the system to equilibrate and then note the pressure reading on the monitor at end-expiration. This IAP reading will last
approximately 2 minutes, at which point the valve will automatically open (drain). Confirm that the AutoValve has opened and
urine is draining normally.
Record the infused saline in the I/Os to adjust for proper
urine output.
4
Interpreting Intra-Abdominal Pressure:1
IAP Pressure Interpretation*
0-5 mm HG
Normal
6-11 mm Hg
Minimal elevation, commonly found in critically ill patients
12-15 mm Hg
Mild to Moderate Intra-Abdominal Hypertension
16-20 mm Hg
Moderate to Severe Intra-Abdominal Hypertension.
Beware of ACS. Significant pathophysiologic changes
may be present.
> 20 mm Hg
ACS – if patient has a sustained IAP > 20 mm Hg that is
associated with new organ dysfunction or failure.
* These are general guidelines. Patient co-morbidities and clinical parameters will influence the clinical significance of
these measurements and the onset of clinically apparent abdominal compartment syndrome.
10 Repeat steps 7-9 every 1-2 hours or as required.
References:
1.Cheatham, M.L., et al., Results from the International Conference of Experts on Intra-abdominal Hypertension and
Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med, 2007. 33(6): p. 951-62.
2.Kimball, E.J., et al., Reproducibility of bladder pressure measurements in critically ill patients. Intensive Care Med, 2007. 33.
3.Davis, et al., Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Med, 2005.
31(3): p. 471-475.
4.De Waele, J.J., et al., Saline volume in transvesical intra-abdominal pressure measurement: enough is enough. Intensive
Care Med, 2006. 32(3): p. 455-9.
Wolfe Tory Medical, Inc. 79 West 4500 South, Suite 18 - Salt Lake City, Utah 84107 - Tel: 801-281-3000 - Fax: 801-281-0708 - www.wolfetory.com
Rev. 09/10
Risk Factors for IAH / ACS
1. Diminished abdominal wall compliance
• Acute respiratory failure, especially with
elevated intrathoracic pressure
• Abdominal surgery with primary fascial or
tight closure
• Major trauma/burns
• Prone positioning, head of bed>30 degrees
• High body mass index (BMI), central obesity
2.
Increased intra-luminal contents
• Gastroparesis
• Ileus
• Colonic pseudo-obstruction
3. Increased abdominal contents
• Hemoperitoneum/pneumoperitoneum
• Ascites/liver dysfunction
•
•
•
4. Capillary leak/fluid resuscitation
• Acidosis (pH <7.2)
•
• Hypotension
•
• Hypothermia (core temperature < 33O C)
•
• Polytransfusion (>10 units of blood/24 hrs)
3
• Coagulopathy (platelets <55000/mm ) OR
prothrombin time (PT)>15 seconds OR partial
thromboplastin time (PTT)>2 times normal
OR international standardised ratio (INR) > 1.5)
Massive fluid resuscitation (>5 L/24 hours)
Pancreatitis
Oliguria
Sepsis
Major trauma/burns
Damage control laparotomy
IAH/ACS Medical
Management Algorithm
IAH Assessment Algorithm
• Patients should be screened for IAH and ACS risk factors upon ICU
admission and with new or progressive organ failure.
• If two or more risk factors are present, a baseline IAP measurement
should be obtained.
• If IAH is present, serial IAP measurements should be performed
throughout the patient’s critical illness.
• The choice (and success) of the medical management strategies listed below is strongly related to both the etiology of the patient’s IAH / ACS and the patient’s clinical situation. The appropriateness of each
intervention should always be considered prior to implementing these interventions in any individual patient.
• The interventions should be applied in a stepwise fashion until the patient’s intra-abdominal pressure (IAP) decreases.
• If there is no response to a particular intervention, therapy should be escalated to the next step in the algorithm.
Patient has IAP >_ 12 mmHg
Begin medical management to reduce IAP
Evacuate intraluminal
contents
Evacuate
intra-abdominal space
occupying lesions
Improve abdominal wall
compliance
Optimize fluid
administration
Optimize systemic /
regional perfusion
Insert nasogastric and/
or rectal tube
Abdominal ultrasound
to identify lesions
Ensure adequate
sedation & analgesia
Avoid excessive fluid
resuscitation
Goal-directed fluid
resuscitation
Remove constrictive
dressings, abdominal
eschars
Aim for zero to negative
fluid balance by day 3
Maintain abdominal
perfusion pressure
_ 60 mmHg
(APP) >
Hemodynamic
monitoring to guide
resuscitation
Initiate gasto-/coloprokinetic agents
Minimize enteral
nutrition
Abdominal computed
tomography to identify
lesions
Avoid prone position,
head of bed > 20
degrees
Resuscitate using
hypertonic fluids,
colloids
Administer enemas
Percutaneous
catheter drainage
Consider reverse
Trendelenberg
position
Fluid removal through
judicious diuresis
once stable
Consider colonoscopic
decompression
Consider surgical
evacuation of lesions
Consider
neuromuscular
blockade
Consider
hemodialysis /
ultrafiltration
Step 4
Step 3
Step 2
IAP measurements should be:
1. Expressed in mmHg (1 mmHg = 1.36 cm H2O)
2. Measured at end-expiration
3. Performed
Performed in
in supine
supine posittion
posittion
3.
4. Zeroed
Zeroed at
at the
the iliac
iliac crest
crest in
in mid-axillary
mid-axillary line
line
4.
(Level of the
urinary
bladder). volume of no greater
5. Performed
with
an instillation
5. Performed with an instillaton volume of no greater
than 25 mL of saline [1 mL/kg for children up to 20 kg]
than 25 mL of saline [1 mL/kg for children up to 20 kg]
(for bladder technique)
(for bladder technique)
6.
Measured
6. Measured 30-60
30-60 seconds
seconds after
after instillation
installationtotoallow
allowfor
for
bladder
bladder detrusor
detrusor muscle
muscle relaxation
relaxation (for
(for bladder
bladder technique)
technique)
7.
7. Measured
Measured in
in the
the absence
absence of
of active
active abdominal
abdominal muscle
muscle
contractions
contractions
Step 1
Measure IAP / APP at least every 4-6 hours or continuously.
Titrate therapy to maintain IAP <_ 15 mmHg and APP >_ 60 mmHg
Adapted from Intensive Care Medicine 2006;32(11):1722-1732 & 2007;33(6):951-962
Vasoactive
medications to keep
_ 60 mmHg
APP >
Discontinue enteral
nutrition
If IAP > 25 mmHg (and/or APP < 50 mmHg) and new organ dysfunction / failure is present, patient’s IAH / ACS is
refractory to medical management. Strongly consider surgical abdominal decompression.
6 West Underwood Street, Suite 201
Orlando, FL 32806
Tel: +01 407 841 5296 Fax: +01 407 648 3686 email: [email protected]
Website: http://www.wsacs.org