Central Venous Pressure

CENTRAL VENOUS CENTRAL VENOUS PRESSUREPRESSURE


DEFINITIONDEFINITION

- the pressure within the - the pressure within the right atrium and represents the filling right atrium and represents the filling pressure of the right ventricle.pressure of the right ventricle.

CENTRAL VENOUS CENTRAL VENOUS PRESSUREPRESSUREPURPOSESPURPOSES

1. Determines fluid status.1. Determines fluid status.

2. Determines pressure on the right 2. Determines pressure on the right side side of the heart. of the heart.

3. Serves as an access for long term IV 3. Serves as an access for long term IV drug administration. drug administration.

4. Route for IV fluids / alimentation.4. Route for IV fluids / alimentation.

CENTRAL VENOUS CENTRAL VENOUS PRESSUREPRESSUREVein sites for catheter Vein sites for catheter

replacementreplacement

• • subclavian veinsubclavian vein

• • jugular veinjugular vein

• • basilic veinbasilic vein

• • femoral veinfemoral vein

CENTRAL VENOUS CENTRAL VENOUS PRESSUREPRESSUREEQUIPMENT SUPPLIESEQUIPMENT SUPPLIES

• cutdown setcutdown set

• CVP catheter (12-24 CVP catheter (12-24 inches long) or inches long) or feeding tube (Fr.8-feeding tube (Fr.8-Pedia) or Triple lumen Pedia) or Triple lumen catheter (optional)catheter (optional)

• infusion solution / infusion solution /

infusion lineinfusion line

• 3-way stopcock3-way stopcock

• CVP manometerCVP manometer

• betadine, cotton betadine, cotton balls, OS 4 x 4, balls, OS 4 x 4, gloves, tapes, gloves, tapes, syringesyringe

• local anesthesialocal anesthesia

• IV poleIV pole

CENTRAL VENOUS CENTRAL VENOUS PRESSUREPRESSURE•Nursing Responsibilities:Nursing Responsibilities:

A. Pre-insertion phaseA. Pre-insertion phase

1. Assemble equipment1. Assemble equipment

2. Explain procedure2. Explain procedure

3. Obtain consent3. Obtain consent

4. Baseline vital signs4. Baseline vital signs

5. Skin preparation5. Skin preparation

6. Position: flat or slightly trendelenberg6. Position: flat or slightly trendelenberg


B. Insertion PhaseB. Insertion Phase1. Stay with the patient (reassurance)1. Stay with the patient (reassurance)

2. Lidocaine infiltration/Lidocaine 2. Lidocaine infiltration/Lidocaine

bolus (standby)bolus (standby)

3. Observe fluid fluctuation with 3. Observe fluid fluctuation with

respiration when attached to CVP respiration when attached to CVP manometer. manometer.


B. Insertion PhaseB. Insertion Phase

4. Monitor for 4. Monitor for dysrhythmiasdysrhythmias

5. Attach fluids and 5. Attach fluids and regulate.regulate.


NORMAL VALUE NORMAL VALUE

a. Water manometera. Water manometer5 - 12 cm H5 - 12 cm H22OO

b. Mercury Systemb. Mercury System 2 - 6 mmHg 2 - 6 mmHg

Phlebostatic Axis DrawingPhlebostatic Axis Drawing

Landmark 1: 4th ICS at edge of sternum,

Landmark 2: posterior chest, directly opposite landmark 1

PHLEBOSTATIC AXIS – halfway bet. Landmarks 1 & 2

Schematic of waveform & Schematic of waveform & cardiac cyclecardiac cycle


C. Post-insertion Phase:C. Post-insertion Phase:

1. Chest x-ray for confirmation1. Chest x-ray for confirmation

2. CVP reading / recording2. CVP reading / recording

a. Patient’s positiona. Patient’s position

b. Phlebostatic axisb. Phlebostatic axis


INDICATIONSINDICATIONS• • Increased CVPIncreased CVP

- Right Ventricular Failure- Right Ventricular Failure

- Volume Overload- Volume Overload

- Tricuspid Valve Stenosis / Regurgitation- Tricuspid Valve Stenosis / Regurgitation

- RV Infarction- RV Infarction

- Pulmonary HPN- Pulmonary HPN


INDICATIONSINDICATIONS

• • Decreased CVPDecreased CVP

- Reduced circulating blood - Reduced circulating blood volumevolume

(Hypovolemia)(Hypovolemia)

CENTRAL VENOUS CENTRAL VENOUS PRESSUREPRESSUREC. Post-insertion Phase:C. Post-insertion Phase:

2. CVP reading / recording2. CVP reading / recording

c. Fluctuation with inspirationc. Fluctuation with inspiration

d. Record reading when level of d. Record reading when level of

solution or fluid stabilizessolution or fluid stabilizes

e. Normal value:e. Normal value:

5-12 cm H5-12 cm H22OO

2-6 mmHg2-6 mmHg


3. Watch out for 3. Watch out for complicationscomplications

POSSIBLE POSSIBLE COMPLICATIONSCOMPLICATIONS

1. Pneumothorax / 1. Pneumothorax / HemothoraxHemothorax

CAUSESCAUSES

- subclavian insertion - subclavian insertion and accidental and accidental injection of air into injection of air into the pleural space or the pleural space or laceration of the laceration of the lungs.lungs.



2. Hemorrhage2. Hemorrhage

3. Infection on 3. Infection on insertion siteinsertion site

CAUSESCAUSES

Presence of Presence of disconnection, leaks, disconnection, leaks, open stopcockopen stopcock

Breakage of aseptic Breakage of aseptic techniquetechnique



4. Dysrrhythmias4. Dysrrhythmias

5. Air Embolism5. Air Embolism

CAUSESCAUSES

IIrritation of the rritation of the endocardium endocardium

disconnections; disconnections; leakages; improper leakages; improper position during position during insertion.insertion.


C. Post-insertion Phase:C. Post-insertion Phase:4. IVF changed every 24 hours.4. IVF changed every 24 hours.

5. IVF tubings changed every 5. IVF tubings changed every

72 hours. 72 hours.

6. TPN/Lipids changed every 6. TPN/Lipids changed every

24 hours.24 hours.

7. Dressings changed aseptically daily7. Dressings changed aseptically daily

and PRN. and PRN.


PROBLEMS CAUSESPRECAUTIONS/

ACTIONS

1. Central venousline does not flow

- kinks

- clots

- relieve line ofkinks

- check stopcock

- check IVFdesired rate

- withdraw clots.DO NOT PUSH


PROBLEMS CAUSESPRECAUTIONS/

ACTIONS

2. CVP readingappears to beinaccurate

- improper position ofpatient andmanometer

- bubbles / clot / kinks

- baseline position;document if nottolerated.

- Observe phlebostaticaxis

- Ascertain that line isfree of bubbles, clots,and kinks.


PROBLEMS CAUSES PRECAUTIONS/ACTIONS

3. Back flowinto the infusionsystem

- leaks; IVF run dry; disconnections

- Desired IVFrate

- Secureconnections

Documents

Central Venous Pressure