What is CVP ?

• The central venous pressure (CVP) is the pressure measured in the

central veins close to the heart.

• It is the pressure measured at the junction of the superior vena cava

and the right atrium. And No valve in between.

• It indicates mean right atrial pressure and is frequently used as an

estimate of right ventricular preload.

• It reflects the driving force for filling of the right atrium & ventricle

• It indicates the relationship of blood volume to the capacity of the

venous system.
Common Insertion Site

• Internal Jugular
• Subclavian
• Femoral
• External Jugular
• Basilic
• Axillary
 Indication
• Major operative procedures involving large fluid shifts
or blood loss .
• Intravascular volume assessment when urine output is
not reliable or unavailable .

• Temporary Hemodialysis .

• Hypotension
 TYPES OF CENTRAL LINE
• SINGLE LUMEN
• DOUBLE LUMEN
• TRIPLE LUMEN
• QUADRUPLE LUMEN
• QUINTUPLE LUMEN
• PERIPHERALLY INSERTED CENTRAL
CATHETERS (PICCS)
Single, Double, and Triple Lumen
Central Lines
• QUADRUPLE LUMEN

• QUINTUPLE LUMEN
PERIPHERALLY INSERTED CENTRAL CATHETERS (PICCS)
PREPROCEDURAL STEPS :-
Explain procedure to the patient or family including its need and
importance.

Provide supine position to the patient.

INTRAPROCEDURE STEPS :-
Wash hands ,it reduce the transmission of infection .
Measuring central venous pressure
Using a manometer

•Line up the manometer

arm with the
phlebostatic axis
ensuring that the
bubble is between the
two lines of the spirit
level
Phlebostatic Axis

4th intercostal space, midaxillary

line
Level of the atria
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
Turn the three-
way tap
off to the
patient and
open to the
manometer
Open the IV
fluid bag
and slowly fill
the
manometer to a
level
higher than the
expected CVP
Turn off the flow
from
the fluid bag
and open
the three-way
tap from
the manometer
to the
patient
The fluid level inside
the
manometer should fall
until gravity equals
the
pressure in the central
veins
• 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.
Turn the
tap off to
the
manometer
veins
 Measuring central venous pressure
Using a transducer
•
Turn the tap off to the
patient and open to the
air by removing the cap
from the three-way port
opening the system to
the atmosphere.
• Press the zero button
on the monitor and
wait while calibration
occurs.
• When 'zeroed' is
displayed on the
monitor, replace the
cap on the three-way
tap and turn the tap
on
to the patient.
• Observe the CVP trace
on the monitor. The
waveform undulates as
the right atrium
contracts and relaxes,
emptying and filling
with blood. (light blue
in this image)
 POSTPROCEDURAL STEPS

1. Observe for any complication from the catheter

insertion site ( pneumothorax , haemothorax , and
embolism )
2. Maintain aseptic technique at the central insertion
site.
3. Change the central line dressing as prescribed.
4. Label the dressing to show the date and time of
change.
• Document the
measurement and
report any changes
or
abnormalities