EXPLAIN THE PROCEDURE:

Begin by explaining in lay terms to your patient what you are about to do. Explain that you need to measure the pressure in their muscles to make certain the pressure is not dangerously high. Let them know that you will begin by giving them numbing medication to make the procedure as painless as possible. You will then insert a needle into the muscle and record its pressure.

GATHER THE MATERIALS:

Now gather all of the materials you will need to perform this procedure: Betadine

• Stryker Pressure Monitor
• Diaphragm chamber
• Side ported 18 g needle.
• 3 cc pre-filled saline syringe
• Gauze
• 1% lidocaine
• 5 cc syringe
• small needle for anesthetic injection
• sterile gloves
• skin marker

PREPARE A STERILE FIELD:

Prepare a sterile field and empty the contents of the disposable pressure monitor pack onto the field using care not to contaminate the area. Other items that are considered sterile include gauze with betadeine solution, the anesthetic syringe and needle, and your sterile gloves. All other items are NOT sterile and should be kept separated to avoid contamination of sterile supplies.

PREPARE YOUR PATIENT:

For all compartment measurements, your patient should lie flat. It has been shown that perfusion pressure to any given compartment falls 0.78 mm Hg for every centimeter it is raised above the level of the right atrium 4,51 .

Observe Universal Precautions. A face shield, protective gown and gloves should be worn.

The proper anatomic site for needle insertion should be located. For measurement of the anterior compartment of the lower leg, this occurs at the junction of the proximal and middle third of the tibia, one cm lateral to the lateral tibial border. (Please refer to the Anatomy section for further discussion of landmarks for various compartments.) As with any procedure, the correct side must be properly identified and if possible confirmed by both the patient and another health care worker. The point of entry is marked with the skin marking pen and then initials are placed below this in view for confirmation.

Now prepare the area with betadeine using sterile technique. Put on sterile gloves. Using circular movements, begin at the center and work your way outwards, This should be repeated three times. A sterile drape is then positioned over the needle entry site. 

Next, you will provide local anesthesia to the overlying skin. Always read the label of the anesthetic to confirm it is the proper medication and concentration. The patient should confirm for you that he/she has no known allergies to the medication. Fill the syringe with lidocaine. The needle is inserted nearly parallel with the skin's surface superficially and a small skin wheal is raised by injection anesthetic. Care should be taken to NOT inject significant amounts of anesthetic deeper as this may further elevate compartmental pressures.

PREPARE EQUIPMENT

Now you will assemble the Stryker apparatus. Turn the unit on by pressing the switch in the upper left hand corner of the unit. Remove the needle and diaphragm chamber from their sterile pouch.

Take the 3 cc pre-filled sterile syringe and first attach to one end of the diaphragm chamber. Next attach the needle to the other end of the diaphragm chamber. All attachments should be secure.

Now open the lid of the Stryker Pressure Monitor by lifting the latch in the bottom left of the apparatus.

measure compartment pressure

Remove the protective needle sheath. With the needle positioned perpendicular to the site of insertion, gently apply pressure until the needle penetrates the skin. The tip of the needle should be only 1-3 cm below the surface of the skin for proper measurement. Now inject 0.3 cc of saline into the compartment to allow interstitial fluid to equilibrate. Once the pressures come to equilibrium, the compartment's pressure may be read and recorded from the display.

CLEAN AND BANDAGE:

Now gently remove the needle. The area is cleansed to remove excess betadeine and a bandage is applied.

RECORD OTHER COMPARTMENT PRESSURES AS NEEDED

You may record other compartment pressures at this time if desired. An alternative site is prepped with betadeine and anesthetized as described above. The unit again is held with the needle pointing in the direction of anticipated insertion, and the unit is re-zeroed. You may now procede as above.