cvp monitoring

1. CENTRAL VENOUS
PRESSURE …
BY LT KALAIVANI R

2. CVP
Central venous pressure (CVP) (also
known as: right atrial pressure; RAP)
describes the pressure of blood in the
thoracic vena cava, near the right atrium of
the heart

3. Normal CVP can be measured from
two points of reference:
•Sternum: 0–14 cm H2O
•Mid axillary line: 8–15 cm H2O

4. Factors that decrease CVP include
Hypovolemia
Deep inhalation
 shock

5. Factors that increase CVP include
•Hypervolemia
•Tension pneumothorax
•Heart failure
•Pleural effusion

7. Central Venous
Catheters

9. Indications
 Long term intravenous antibiotics
 Chemotherapy
 Total paranteral nutrition
 Dialysis
 Monitoring CVP
 Limited vascular access
 Administering large amount of blood &
blood products.

12. Types Of Central Venous Catheters
 Nontunneled central catheters
 Tunneled central catheters
 Peripherally inserted central catheters
(PICC)
 Implantable ports

13. Nontunneled Central Venous
Catheters
 Used for short-term therapy
 Inserted percutaneously
 Subclavian vein
 Internal jugular vein
 Femoral vein
 Has from 1 to 4 lumens or ports
 Usually from 6 to 8 inches in length

15. Tunneled Central Venous
Catheters
 Used for long term therapy
 Inserted surgically
 Small Dacron cuff sits in subcutaneous tunnel
 Initially sutured but removed in 7 to 10 days
 External portion of the cath can be repaired

17. Tunneled CVC

18. Peripherally Inserted Central
Catheters (PICC)
 Used for intermediate to long term therapy
 May be single or double lumen
 Inserted percutaneously
 Basalicvein
 Cephalic vein
 Threaded into the superior vena cava
 May be inserted by specially trained RN

20. Implantable Ports
 Used for long term therapies
 Surgically implanted
 Consists of metal or plastic housing
 Silicone cath placed in superior vena cava
 Dressing required until insertion site healed

22. Equipment

23. For intermittent CVP
monitoring
 Disposable CVP manometer set
 leveling device (such as a rod from a reusable
CVP pole holder or a carpenter’s level or rule) ,
 additional stopcock (to attach the CVP
manometer to the catheter)

24.  extension tubing (if needed)
 I.V. Pole,
 I.V. solution ,
 I.V. drip chamber and tubing
 dressing materials
 and tape.

25. Implementation
 Gather the necessary equipment.
 Explain the procedure to the patient to reduce his
anxiety.
 Assist the physician as he inserts the CV catheter.

26. Complications
 Infection
 Phlebitis
 Septicemia or pyrogenic reaction
 Air embolism
 Thrombosis/occlusion
 Extravasations
 pneumothorax

27. CENTRAL VENOUS PRESSURE
MONITORING

28.  CVP monitoring helps
to assess cardiac function,
to evaluate venous return to the heart,
 to indirectly know how well the heart is
pumping

29.  To measure the patient’s volume status, a
disposable plastic water manometer is attached
between the I.V. line and the central catheter
with a three- or four-way stopcock.
 CVP is recorded in centimeters of water (cm
H2O) or millimeters of mercury (mm Hg) read
from manometer markings.

30. MEASURING CVP WITH
A WATER MANOMETER
To ensure accurate (CVP) readings, make sure
the manometer base is aligned with the patient’s
right atrium (the zero reference point).

31. The manometer set usually contains a
leveling rod to allow you to determine this
quickly.
After adjusting the manometer’s position,
examine the typical three-way stopcock.

32. By turning it to any position shown at right,
you can control the direction of fluid flow.
Four-way stopcocks also are available

33.  All openings blocked

34.  Manometer to patient

35.  I.V. solution to manometer

36.  I.V. solution to patient

37. I.V.
solution
bottle
Manometer
Zero point
Three-way stopcock

38.  Turn the stopcock off to the patient, and
slowly fill the manometer with I.V. solution until
the fluid level is 10 to 20 cm H2O higher than
the patient’s expected CVP value.
Don’t overfill the tube because fluid that spills
over the top can become a source of
contamination.

39.  Turn the stopcock off to the I.V. solution and
open to the patient.
 The fluid level in the manometer will drop.
 When the fluid level comes to rest, it will
fluctuate slightly with respirations.
 Expect it to drop during inspiration and to rise
during expiration.
 Record CVP at the end of expiration, when
intrathoracic pressure has a negligible effect.

40. Depending on the type of water manometer
used, note the value either at the bottom of the
meniscus ‫ أسفل السطح المحدب‬or at the midline
of the small floating ball.
 After you’ve obtained the CVP value, turn the
stopcock to resume the I.V. infusion.
Adjust the I.V. drip rate as required.
Place the patient in a comfortable position.

41. General Nursing Care Of Patient
With CVC
 Before insertion, lines are initially
flushed with saline
 During percutaneous insertion of CVC in
the subclavian or jugular, place patient in
Trendlenberg or have him perform
Valsalva maneuver

42.  After insertion, an occlusive gauze or
transparent dressing is applied
 Blood is aspirated through all lumens to
verify patency
 Chest xray must be performed before use

44.  Flushing of lines
 Each lumen is treated as a separate cath
 Injection caps are vigorously cleaned with
alcohol
 Use 10cc or larger syringe for administration
of meds or flush
 Turbulent flush technique is recommended

45.  Site assessment and determination of
external cath length is performed and
documented with each dressing change
 Tubings are changed per protocol – 72hrs
 Caps and connections are changed per
protocol – 3-7 days

46.  When to call the physician
 Temp of 100.5F or greater
 Chills, dyspnea, dizziness
 Pain, redness, swelling, or drainage at site
 Unresolved resistance, pain or fluid leaking while
flushing
 Hole or tear in cath
 Excessive bleeding at site
 Change in length of external cath
 Swelling in neck, face, chest, or arm

47.  General safety measures
 No sharp objects near cath
 Clamp cath when not in use
 No pulling or tension on the cath
 Activity limitations

48. Discontinuing A CVC
 Follow the institution’s policy and procedure
 For percutaneous internal jugular or subclavian
insertion sites, place patient in trendlenburg
position and have him perform the Valsalva
maneuver

49. •Remove cath and apply pressure with an
occlusive dressing over a petroleum gauze
•Check cath to ensure tip is intact
•Document how patient tolerated procedure,
placement of dressing and cath tip intact.

50. Documentation
 Document all dressing, tubing, and solution
changes.
 Document the patient’s tolerance of the
procedure,
 the date and time of catheter removal, and the
type of dressing applied.
 Note the condition of the catheter insertion site
and whether a culture specimen was collected.
 Note any complications and actions taken.

51. CONCLUSION
 C Central Venous you.flv