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CENTRAL VENOUS PRESSURE
LEARNING OUTCOMES
By the end of this session the student
should be able to :
• Explain the indicat...
CENTRAL VENOUS PRESSURE
DEFINITION
Blood from the systemic veins flows
into the right atrium.
The pressure in the right at...
CENTRAL VENOUS PRESSURE
PURPOSE
• To serve as a guide of fluid balance
in critically ill patients
• To estimate the circul...
CENTRAL VENOUS PRESSURE
Axillary vein
Cephalic vein
Median cubital vein
Basilic vein
ACCESS
External Jugular vein
Subclavi...
CENTRAL VENOUS PRESSURE
COMPLICATIONS
• Carotid Artery Puncture
• Pneumothorax
• Air Embolism
• Arrhythmia
• Perforation o...
CENTRAL VENOUS PRESSURE
EQUIPMENT
The equipment needed for measurement of
central venous pressure includes a sterile bag
o...
CENTRAL VENOUS PRESSURE
EQUIPMENT
IV extension
set to entry port
of patients
central line.
IV giving set
to fluid bag.
Sto...
CENTRAL VENOUS PRESSURE
DIRECTION OF FLOW
The white arrows indicate the direction of fluid flow.
Initially the white knob ...
CENTRAL VENOUS PRESSURE
POSITION OF PATIENT
3-way tap
manometer
Fluid
Bag
Patient in supine position
Central
Venous
Access
CENTRAL VENOUS PRESSURE
INTERPRETATION
• An increase of above normal may
indicate weakening or failure of the
right side o...
CENTRAL VENOUS PRESSURE
DETERMINANTS
Cardiac Competence
(reduced ventricular
function raises CVP)
Blood Volume
(increased ...
CENTRAL VENOUS PRESSURE
REFERENCES
Henderson N., (1997) Central Venous Lines
Nursing Standard 11:42, pp49-56
Mallett J., (...
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Cvp

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CVP MONITORING

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Cvp

  1. 1. CENTRAL VENOUS PRESSURE LEARNING OUTCOMES By the end of this session the student should be able to : • Explain the indications for a patient requiring CVP monitoring • Identify the equipment required for commencing CVP monitoring • Describe the nursing role, both in the care and use of the central venous monitoring line • Discuss the reasons for abnormal CVP readings.
  2. 2. CENTRAL VENOUS PRESSURE DEFINITION Blood from the systemic veins flows into the right atrium. The pressure in the right atrium is the CVP. A catheter is passed via; the subclavian vein or jugular vein into the superior vena cava to determine the venous return and intravascular volume of the right atrium. The normal value is 5-10cm H2O
  3. 3. CENTRAL VENOUS PRESSURE PURPOSE • To serve as a guide of fluid balance in critically ill patients • To estimate the circulating blood volume • To determine the function of the right side of the heart • To assist in monitoring circulatory failure • None of these variables are measured directly; they must be interpreted.
  4. 4. CENTRAL VENOUS PRESSURE Axillary vein Cephalic vein Median cubital vein Basilic vein ACCESS External Jugular vein Subclavian vein
  5. 5. CENTRAL VENOUS PRESSURE COMPLICATIONS • Carotid Artery Puncture • Pneumothorax • Air Embolism • Arrhythmia • Perforation of SVC or R. Atrium/Ventricle • Infection • Pleural Effusion • Extravasion of Infusate • Allergic reaction to catheter material
  6. 6. CENTRAL VENOUS PRESSURE EQUIPMENT The equipment needed for measurement of central venous pressure includes a sterile bag of fluids (a) with attached fluid administration set (b), an IV extension set (c), a manometer (d) and a stopcock (e). a. b. c. d. e.
  7. 7. CENTRAL VENOUS PRESSURE EQUIPMENT IV extension set to entry port of patients central line. IV giving set to fluid bag. Stopcock (Three way tap)
  8. 8. CENTRAL VENOUS PRESSURE DIRECTION OF FLOW The white arrows indicate the direction of fluid flow. Initially the white knob is turned straight up towards the manometer, allowing fluid to flow from the fluid bag to the patient's catheter to assure the catheter is patent (a). If fluid does not flow freely into the patient's catheter a valid CVP reading will not be obtained. Then the knob is turned toward the patient (b) and fluid will fill the manometer. The manometer should not contain any air bubbles. If air is present in the manometer or fluid line, let the fluids run, overfilling the manometer until all air is purged from the system. Then turn the knob toward the fluids (c). The level of fluid in the manometer will fall (the fluid is running into the patient's catheter) until the height of the fluid column exerts a pressure equivalent to the patient's central venous pressure. The top of the fluid column will slightly oscillate up and down as the animals' heart beats and as the animal breathes. a. c.b.
  9. 9. CENTRAL VENOUS PRESSURE POSITION OF PATIENT 3-way tap manometer Fluid Bag Patient in supine position Central Venous Access
  10. 10. CENTRAL VENOUS PRESSURE INTERPRETATION • An increase of above normal may indicate weakening or failure of the right side of the heart, or excessive intravascular volume • A pressure below 5cm H2O usually reflects an intravascular volume deficit or drug induced excessive vasodilation • CVP measurements must not be interpreted on their own, but viewed alongside the patient's full clinical picture (BP, Respiratory Pattern, Colour, Temperature) • Several measurements are required to identify a trend
  11. 11. CENTRAL VENOUS PRESSURE DETERMINANTS Cardiac Competence (reduced ventricular function raises CVP) Blood Volume (increased venous return raises CVP) Intra Aortic & Intra Peritoneal Pressure (raises CVP) Systemic Vascular Resistance (raises CVP) CVP
  12. 12. CENTRAL VENOUS PRESSURE REFERENCES Henderson N., (1997) Central Venous Lines Nursing Standard 11:42, pp49-56 Mallett J., (2000) The Royal Marsden NHS Trust Dougherty L., Manual of Clinical Nursing Procedures, Fifth Edition Oxford; Blackwell Science, pp630-635. Mc Dermott M., (1995) Central Venous Pressure Nursing Standard 9:35, pp54 Nursing Standard., (1999) Quick Reference Guide 6. Central Venous Lines Nursing Standard 13:42.

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