Central Venous

Pressure MonitoringBy: Kris Lyn L. Tejerero

Central Venous Pressure (CVP) Is the pressure in the

vena cava or right atrium

CVP represents the driving force for filling the right atrium and ventricle

Is used to assess right ventricular function and venous blood return to the right side of the heart

Central Venous Pressure (CVP) CVP can be continuously

measured by connecting either a catheter positioned in the vena cava or the proximal port of pulmonary artery to a pressure monitoring system

Patient’s in general medical-surgical units who require CVP monitoring may have single-lumen or multilumen catheter placed in the superior vena cava.

Central Venous Pressure (CVP) Intermittent measurement of

the CVP can then be obtained with the use of water manometer.

CVP can also be seen as a measurement of preload on the right side of the heart.› Preload – is the amount of

blood presented to the heart or when the ventricle is full before the next ejection. Preload is the right ventricle end-diastolic pressure.

Normal CVP pressure is 2 to 6 mm Hg. › Other book/source: 2 - 12 mm Hg or 4

- 10 mm Hg

Purpos

e To serve as a guide to fluid

replacement in seriously ill patients.

To estimate blood volume deficits.

To determine pressures in the right atrium and central veins.

To evaluate for circulatory failure (in context with total clinical picture of patient)

For drug administration (long term chemotherapy)

To serve as a route for hyper alimentation.

recorded at the end of expiration

measured by transducing the waveform of a central venous line

electronic transducer placed & zeroed at the level of the RA (the “phlebostatic axis” – usually the 4th intercostal space in the mid-axillary line is used)

MEASUREMENT

Vascular access Total parenteral nutrition Infusion of irritant drugs Measurement of central

venous pressure Cardiac catheterization Pulmonary artery

catheterization Trans venous cardiac

pacing. Hemo dialysis Hemodynamic monitoring

INDICATIONS

Do not insert into an infected area.

Avoid infraclavicular approach to subclavian vein if patient has apical emphysema or bullae.

Avoid internal jugular vein if carotid aneurysm present on the same side.

Bleeding diatheses Septicaemia Hypercoagulable states

CONTR

A-

INDIC

ATIO

NS

COMMON COMPLICATIONS

Infection Air Embolism

A drop in CVP indicates decreased in circulating volume w/c may result from:

Fluid Imbalance Hemorrhage Severe vasodilatation Pooling of blood in the extremities

with limited venous return

A rise in CVP indicates an:

Increase blood volume because of a sudden shift on fluid balanceExcessive Iv infusionRenal FailureSodium or water retention

IMPORTANCE OF CVP MONITORING

CVP catheter is inserted, it is secured and dry, sterile dressing is applied. Rationale: Sterile procedure and dressing prevents blood stream infections.

Catheter placement is confirmed by a chest x-ray and the site is inspected daily for signs of infection. Rationale: Chest x-ray can detect malpositions of the catheter. To prevent wound infection.

NURSING INTERVENTIONS

CVP catheter can be used for infusing IV fluids, administering IV medications and drawing blood specimens in addition to monitoring pressure.

To measure CVP, the transducer must be placed must be placed at a standard reference point called the phlebostatic axis. And CVP can be measured correctly with the patient supine and backrest position up to 45 degrees. Rationale: Reduces risk of air embolism during insertion And CVP can be measured correctly with the patient supine and backrest position up to 45 degrees.

NURSING

INTERVENTIONS

Normal CVP Monitoring CVP WAVEFORM ANALYSIS

› Dominant a wave – pulmonary hypertension,

› Cannon a wave – complete heart block, (VT) ventricular tachycardia with AV dissociation

› Dominant v wave – (TR) Tricuspid Regurgitation

› Absent x descent – (Af) Atrial Fibrilation› Exaggerated x descent – pericardial

tamponade, constrictive pericarditis› Sharp y descent – severe TR, constrictive

pericarditis› Slow y descent – TR, atrial myxoma› Prominent x and y descent – Right

Ventiricle (RV) infarction

The End

THANK

YOU