Central Venous Pressure Central Venous Pressure  is considered a direct measurement of the blood pressure in the right atrium

and vena cava. It reflects the pressure of the blood in the right atrium.  is used to assess right ventricular function and venous blood return to the right side of the heart.  Because the pressures in the right atrium and right ventricle are equal at the end of diastole (0 to 8 mm Hg), the CVP is also an indirect method of determining right ventricular filling pressure (preload).  It is acquired by threading a central venous catheter (subclavian double lumen central line) into any of several large veins.  It is threaded so that the tip of the catheter rests in the lower third of the superior vena cava.  The pressure monitoring assembly is attached to the distal port of a multilumen central vein catheter.  Engorgement is estimated by how far the venous column can be observed as it rises from an imagined angle at the point of manubrium (angle of Louis).  Normally, the jugular venous column rises no higher than 2-3 cm above the clavicle with the client in a sitting position at a 45 angle.  Objectives: a. To serve as a guide for fluid replacement in seriously ill patients. b. To estimate blood volume deficits. c. To determine pressures in the right atrium and central veins. d. To evaluate for circulatory failure. Indications: Patients having Cardiovascular disorders; Hemodynamic monitoring; Administration of medications; Transvenous cardiac pacing; Plasmapheresis, apheresis, hemodialysis, or continuous renal replacement therapy; Poor peripheral venous access. Contraindications: Relative contraindications for subclavian insertion include bilateral pulmonary pathology, highpressure mechanical ventilation, and altered local anatomy. If one attempt at subclavian insertion has been unsuccessful, an attempt on the opposite subclavian is relatively contraindicated because of the risk of bilateral pneumothorax Complications: Infection and thrombosis; Arrhythmia; Vascular injury; Pulmonary complications; Venous air embolism

 CVP is a measurement of:

Central Venous Pressure

Prepared by: Prisicilla Pat

  

Cardiac efficiency Blood volume Peripheral resistance

y y y

How to measure: y A catheter is passed from a cutdown in the antecubital, subclavian jugular, or basilic vein to the right atrium and attached to a precalibrated manometer or transducer. y Patient should be flat with the zero point of manometer at the same level as the right atrium, which corresponds to the mid-axillary line of the patient or approximately 5cm below the sternum. y Fluctuations follow the patients respiratory function and will fall on inspiration and rise on expiration due to changes in intrapulmonic pressure. Reading should be obtained at the highest point of fluctuation. y If patient is using ventilator, its used should be discontinued during the reading of the CVP. Normal CVP: 2 to 8 cm H2O or 2 to 6 mmHg Decrease in CVP:  hypovolemic shock from hemorrhage, fluid shift, dehydration  negative pressure breathing which occurs when the patient demonstrates retractions or mechanical negative pressure which is sometimes used for high spinal cord injuries. Increased in CVP:  overhydration which increases venous return  heart failure or PA stenosis which limit  venous outflow and lead to venous congestion  positive pressure breathing, straining

y y y

y y

Adhere to institutional Policy and Procedure. Obtain history and assess the patient. Explain the procedure to the patient, include: o local anesthetic o trendelenberg positioning o draping o limit movement o need to maintain sterile field. o post procedure chest X-ray Obtain a sterile, flushed and pressurized transducer assembly Obtain the catheter size, style and length ordered. Obtain supplies: o Masks o Sterile gloves o Line insertion kit o Heparin flush per policy Position patient supine on bed capable of trendelenberg position Prepare for post procedure chest Xray

Nursing Interventions: 1. Once the CVP catheter is inserted, it is secured and a dry, sterile dressing is applied. Catheter placement is confirmed monitoring system are changed according by a chest x-ray, and the site is inspected daily for signs of infection. 2. The dressing and pressure to hospital policy. In general, the dressing is kept dry and air occlusive. Dressing changes are performed using sterile technique. 3. CVP catheters can be used for infusing IV fluids, administering IV medications, and drawing blood specimens in addition to monitoring pressure. 4. The transducer must be placed at a standard reference point, called the phlebostatic axis. When the phlebostatic axis is used, then the CVP can be measured correctly with the patient supine at any backrest position up to 45 angle.

Assisting with CVP placement

Central Venous Pressure

Prepared by: Prisicilla Pat

Central Venous Pressure

Prepared by: Prisicilla Pat