You are on page 1of 4

Policy/ Procedure

TITLE: Central Venous Pressure


Monitoring

NUMBER: 717

Effective Date:
DRAFT

Page: (1 of 4)

February 2013

Applies To: Registered Nurses caring for patients requiring Central Venous Pressure
Monitoring (6 Link Inpatient and Renal Dialysis Unit (RDU))

THIS SKILL IS A BEYOND ENTRY LEVEL COMPETENCY (BELC) FOR


REGISTERED NURSES PRACTICING AT THE IWK HEALTH CENTRE
POLICY
Central Venous Pressure (CVP) Monitoring will be performed according to the following protocol
and guidelines. CVP Monitoring is a Beyond Entry Level Competency (BELC) for registered
nurses (RNs) practicing on the 6 Link Inpatient Unit and Renal Dialysis Unit (RDU). This BELC
requires initial certification, demonstration of competency, and ongoing annual recertification.
The purpose of CVP monitoring is to determine the function of the right atrium and the venous
blood pressure within the superior vena cava, in particular cardiac function and blood volume
returning to the right side of heart.

DEFINITIONS
Central Venous Pressure (CVP) - a measure of the right atrium function and the venous blood
pressure within the superior vena cava.

PROTOCOL
Measurements will be taken in the same position each time.
A CVP reading will be taken at the end of a respiratory expiration, to optimize accuracy.
Zeroing is performed to eliminate the effects of atmospheric pressure on the transducer and
thus altering the reading.
Leveling is performed to eliminate the effects of hydrostatic pressure on the transducer. Any
change in the patients position or level of bed will alter hydrostatic pressure and therefore
require re-zeroing of CVP set-up before taking a reading.

This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the server file version prior to use.

Central Venous Pressure Monitoring

Page 2 of 4

The normal reading for central venous pressure is 2-6 mmhg. Check with physician regarding
desired range of readings for each individual patient. Post kidney transplant patients often
require a CVP reading higher than normal i.e. 4-8 mmhg.

PROCEDURE
Note: CVP monitoring is a 2 person procedure.
Equipment
-Level
-Mask
-Sterile Gauze
-Monitor capable of measuring CVP
1. Perform hand hygiene.
2. Turn monitor on. Ensure monitor cable is plugged into BP2 and not BP1 connection
on monitor. The module cable can be labeled CVP for clarity.
3. Ensure the pressure cable is connected to the transducer and that the CVP line has
been infusing. If the CVP line is not a designated lumen and Yed via a stop cock
with another IV line, turn the stopcock off to alternate line for at least 15 mins prior as
well.
4. Ensure that the CVP line is the only IV infusing via that lumen at the time of checking
CVP pressure.
5. Repeat hand hygiene.
6. Position patient in a supine or semi-recumbent position.
7. Locate the 4th intercostals space on chest. Follow this space to the mid axillary line
(right atrium). This site is the zero line. Mark it with an X.
8. Using the level, align the x with the transducer. The assistant then adjusts the
transducer to the level.
9. NOTE: If chest has a dressing or an anatomical deformity, then the site of the x will
have to be based on an x-ray or ultrasound measurement.
10. Turn transducer stopcock off to patient. If other infusions are running in the same
lumen, put the corresponding pumps on hold while doing reading.
11. Wearing mask, use gauze to remove cap on transducer. In NICU loosen cap turn
and do not remove.
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the server file version prior to use.

Central Venous Pressure Monitoring

Page 3 of 4

12. Zero the monitor according to manufacturers instructions (i.e. zero BP2). See image
below for monitor screen example.
13. When line is zeroed replace cap (tighten cap in NICU) and turn stopcock off to
closed cap.
14. Once the reading is stabilized, observe and record. If reading is not within desired
range, report to physician. Repeat readings as per physician order.

REFERENCES
Cole, E. Measuring Central Venous Pressure.
http://docsm14.webs.com/CVP.pdf
Central
Venous
Pressure
monitoring.
http://www.rnceus.com/hemo/cvp.htm

Retrieved

Retrieved

on

on

July 18,

July

18,

2012

2012

from

from

Alkaissi, A. Central Venous Pressure Monitoring. Retrieved on July 18, 2012 from
elearning.najah.edu/.../2571CENTRAL%20VENOUS%20PRESSURE.ppt
Central Venous Pressure Monitoring. St George Hospital ICU Nursing Procedure Manual.
Revised Novemeber 2004. Retrieved July 17, 2012 from
http://intensivecare.hsnet.nsw.gov.au/five/doc/CVP_measurement_HM_stgeorge.pdf
Higgins, Dan (October 26, 2004). CVP Monitoring. Nursing Times. 100 (43), 32-33.
Update in Anesthesia. (2000). Issue 12. Article 13. Central Venous Access and Monitoring.
Pages 1-4.
Woodrow, Philip. Central Venous Catheters and Central Venous Pressure. Nursing Standard:
March 13-19, 2002; 16, 26. Proquest Nursing Journals. Page 45.
Central Venous Access and Monitoring: Practical Procedures. Update in Anesthesia. Issue 12
(2000), Article 13: Page 1-5.
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the server file version prior to use.

Central Venous Pressure Monitoring

Page 4 of 4

Hemodynamic in Critical Care: Hemodynamic Monitoring Overview, NurseBob, 12/04/00. page


1-9. http://rnbob.tripod.com/hemod.htm

RELATED DOCUMENTS
Policies: Central Venous Pressure Monitoring Set-Up Policy # 4707
Learning Packages: Central Venous Pressure Monitoring: Learning package. A shared
competency. (December 2004). IWK Health Centre.

***

This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the server file version prior to use.