ask an expert
Understanding the
phlebostatic axis
By Chelsea Iversen, MS, RN
Trauma ICU RN Erie County Medical Center Buffalo, N.Y.
Q: Whats the phlebostatic axis and what
Accurate does it mean when monitoring my pa-
measurements tients vital signs?
are our aim! A: Venous and arterial catheters provide
the most accurate method for hemodynamic
monitoring. The nurse must be confident
that central venous pressure (CVP) and
arterial BP measurements are accurate.
The phlebostatic axis is the reference point
for zeroing the hemodynamic monitoring
device. This reference point is important
because it helps to ensure the accuracy of
the various pressure readings. Nurses must
ensure the accuracy of their hemodynamic
monitoring devices.
Several factors can produce artifacts that
decrease the accuracy of pressure moni-
toring, which establishes a risk of error in
patient management. These factors include
the length of the pressurized I.V. tubing
(4 foot-long tubing is preferred to facilitate
accurate placement and zeroing of devices),
air bubbles in the system, and incorrect
placement of the device stopcock at an inac-
curate reference point. Understanding the
phlebostatic axis, particularly its importance
as a reference point for stopcock placement,
helps to ensure accurate readings.
With the head of bed at 60 degrees or
less, the phlebostatic axis is located at the
fourth intercostal space at the mid-anterior-
posterior diameter of the chest wall.
This is the location of the right atrium,
where the tip of a CVP catheter would
lay. Maintaining the device stopcock at
the phlebostatic axis will help ensure a
proper reading. If the stopcock is posi-
tioned below the phlebostatic axis, the
readings will be erroneously high; if above
the phlebostatic axis, the readings will be
erroneously low. Either error can lead to
mismanagement of patients and their care.
56 Nursing made Incredibly Easy! September/October 2011
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The device should be zeroed once each
day and whenever the accuracy of a read-
ing has been called into question. Zeroing
of the device with the patient in an impro-
per position can lead to inaccurate mea-
surements. A backrest position of less than
or equal to 60 degrees with the patients
back flat against the surface of the bed
wont compromise the accuracy of the
reading. Positioning a patient in a
90-degree lateral position is the only
acceptable side-lying position that wont
affect the reading.
In this case, the reference points for zero-
ing the pressure monitoring system change.
In a right lateral position, at 90 degrees with
the backrest flat, the zeroing reference point
is the intersection of the fourth intercostal
space and midsternum. In a left lateral posi-
tion, at 90 degrees with the backrest flat, the
zeroing reference point is the intersection of
the fourth intercostal space and the left para-
sternal border.
Continuous and accurate hemodynamic
measurements may be lifesaving for criti-
cally ill patients. Improper use endangers
patient outcomes.
Learn more about it
Bridges EJ. Pulmonary artery pressure monitoring:
when, how, and what else to use. AACN Adv Crit Care.
2006;17(3):286-303.
Cheatham ML. Hemodynamic monitoring: principles to
practice. http://www.surgicalcriticalcare.net/Lectures/
PDF/hemodynamic%20monitoring%20principles%20
to%20practice.pdf.
Leeper B. Obtaining valid hemodynamic measures:
evidence-based practice. http://www.aacn.org/DM/
CETests/Overview.aspx?TestID=651&mid=2864&Item
ID=64.
The author has disclosed that she has no significant rela-
tionship with or financial interest in any commercial com-
panies that pertain to this educational activity.
DOI-10.1097/01.NME.0000403195.75792.a4
www.NursingMadeIncrediblyEasy.com