Central Venous Pressure

(CVP)

(CVP) Central Venous Pressure

O Is a measure of the pressure within the

right atrium of the heart. O It measures the ability of the right side of the heart to deal with the systemic fluid load. O Its changes reflect the clients overall fluid volume status.

Indications
O CVP measurement
O Drug and fluid administration O Nutrition and feeding O Cardiac pacing

Other Indications
O Fluid resuscitation in major trauma
O Cardiac surgery O Thoracic surgery O Major abdominal surgery O To optimize fluid replacement in acute

renal failure O To optimize fluid replacement during sepsis O To guide fluid replacement in heart failure

Normal CVP= 2-6 mmHg

CVP is affected by:

O Intrathoracic

pressure or musculoskeletal pump O Vascular tone O Obstruction

2 Common type of CVP

O CVP is measured using

an indwelling central venous catheter (CVC) and a pressure manometer or transducer. Both methods are reliable when used correctly.

O Accident and Emergency departments, High

Dependency areas and Intensive Care units use transducers for measuring CVPs.

O To ensure the

accuracy of the CVP Reading, the manometer must always be positioned in the same place, relative to the right atrium.

Nursing Process

Assessment
1. Assess the clients ability to lie in a

supine position without a pillow. 2. Assess the clients vital signs and intake and output.

Diagnosis
O Risk for infection
O Risk for deficient fluid volume O Impaired skin integrity

Planning
O Expected Outcomes:
1. The clients CVP will be measured

accurately. 2. The aseptic technique will be maintained. 3. The client will not suffer any complications as a result of the CVP measurement.

Equipment Needed
O Sterile gloves O IV Tubing O Manometer set or pressure

O
O O

O
O

transducer setup Stopcock (if not included in the set) Indelible ink marking pen Tape Mask Normal Saline

O Estimated time to complete the skill is 5-

10 minutes

Implementation

Preparatory Phase (Nurse)

Explain the procedure to patient . Position patient appropriately .Place patient in supine position 3. Flush IV infusion set and manometer or prepare heparin flush for use with transducer . Secure all connections to prevent air emboli and bleeding .
1. 2.
a.

b.

Attach manometer to IV pole .The zero point of the manometer should be on level with the patient right atrium. Zero transducer & level port with pt right atrium.

4.

4- Place ECG monitoring.

Insertion phase : ( by physician )

1.
2. 3.

4. 5. 6.

The CVP site is surgically cleaned Assist the patient to remaining motionless during insertion . Monitor for dysrhythmias , tachypnea, tachycardia as catheter threaded to great veins is connect primed IV tubing to catheter and allow IV solution to flow . The catheter should be suture in place . Place a sterile occlusive dressing over site. Obtain a chest x-ray.

CVP Measurement

1. Line up the manometer arm with the phlebostatic axis ensuring that the bubble is between the two lines of the spirit level.

Move the manometer scale up and down to allow the bubble to be aligned with zero on the scale. This is referred to as 'zeroing the manometer'.

O Turn the three-

way tap off to the patient and open to the manometer.

O Open the IV fluid bag

and slowly fill the manometer to a level higher than the expected CVP

O Turn off the

flow from the fluid bag and open the threeway tap from the manometer to the patient

O The fluid level

inside the manometer should fall until gravity equals the pressure in the central veins

O When the fluid stops falling the CVP

measurement can be read. If the fluid moves with the patient's breathing, read the measurement from the lower number.

O Turn the tap off to

the manometer

Low CVP reading is caused by

O Hemorrhage O Excessive dieresis- result of diabetes or

diuretic therapy O Poor venous return- eg. Cardiogenic shock O Peripheral vasodilation- result of septicemia or vasodilatory therapy

High CVP reading is caused by:

O Hypervolemia- occurs with excessive fluid infusion
O Cardiac failure O High blood viscosity- massive blood transfusion O Lumen occlusion/obstruction- cannula might be

kinked or resting against the vein wall, or the patient might have thrombus O Artifact- caused by mechanical interference (eg. Viscous drugs or fluids remaining in the CVP line or in progress while CVP is being measured O User error- air filter in the manometer can become wet

Special Considerations
O Arrange for daily chest X-rays to check
O O O

catheter placement, as ordered. Care for the insertion site according to facility policy. Change the dressing every 24 to 48 hours. Be sure to wash your hands before dressing changes; use aseptic technique and sterile gloves when redressing the site. When removing the old dressing, observe for signs of infection, such as redness, and note patient complaints of tenderness.

O Apply ointment if directed by facility policy,

then cover the site with a sterile gauze dressing or a clear occlusive dressing. O After the initial CVP reading, reevaluate readings frequently to establish a baseline for the patient. O Authorities recommend obtaining readings at 15-, 30-, and 60- minute intervals to establish a baseline. O If the patients CVP fluctuates by more than 2 cm H2O, suspect a change in his clinical status and report this finding to the physician.

O Change the IV solution every 24 hours and

the IV tubing every 48 hours, according to facility policy. O Expect the physician to change the catheter every 72 hours. O Label the IV solution, tubing, and dressing with the date, time, and your initials.
O Source: Nurses Quick Check: Skills, by

Lippincott Williams & Wilkins, page 99.

Potential Complications
O Haemorrhage
O Catheter O Infection O Air Embolus O Catheter Displacement