CVP MONITORING

Prepared By
Trevor Thomas

OBJECTIVES
At the end of the session the students will
be able to:
Define CVP.
Discuss the Indication and Contraindication.
How it is performed.
Elaborate the basic principles.
How to write nursing notes.
Discuss regarding Waveform on Monitor.
Define Nursing Care.

CVP
A Central Venous Catheter (CVC) is an
indwelling intravenous device that is
inserted into a vein of the central
vasculature.

INDICATION

Central venous pressure monitoring

Volume resuscitation
Cardiac arrest
Lack of peripheral access
Placement of transvenous pacemaker
Cardiac catheterization, pulmonary
angiography
Hemodialysis

CONTRA-INDICATION

Bleeding disorders
Anticoagulation or thrombolytic therapy
Combative patients
Distorted local anatomy
Cellulitis, burns, severe dermatitis at site
Vasculitis

TECHNIQUE

Use

introducing needle to locate vein

Wire is threaded through the needle
Needle is removed
Skin and vessel are dilated
Catheter is placed over the wire
Wire is removed
Catheter is secured in place

Basic Principles

Decide if the line is really necessary.

Know your anatomy.

Be familiar with your equipment.

Obtain optimal patient positioning and cooperation and take your time.

Use sterile technique and ask for help.

Always aspirate as you advance as you withdraw the needle slowly.

Always withdraw the needle to the level of the skin before redirecting
the angle.

Obtain chest x-ray post line placement and review it

Common insertion areas

Right internal jugular vein

Left internal jugular
Right subclavian
Left subclavian
Femoral

Advantages
&
Disadvantages

How to write a NOTE?

Name of procedure
Indication for procedure
Comment on consent, if applicable
Describe what you did, including prep
Comment on aspiration/flushing of ports
How did patient tolerate procedure
Any complications

CVP waveform
The CVP waveform reflects changes in right atrial
pressure during the cardiac cycle

CVP waveform

a wave: Atrial contraction.

c wave: Closure of Tricuspid valve at start of Right

ventricular contraction.

x descent: Atrial Relaxation.

v wave: Passive filling of right atrium and vena cava

when tricuspid valve kept closed.

y descent: tricuspid valve opens and blood flows into

right ventricle.

What factors
INCREASES and
DECREASES CVP?

Nursing Care

Close observation
Vital sign
Handling of Lines
Dressing as per policy
Post removal care
Lab checks