Central Venous Pressure Monitoring
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Transcript of Central Venous Pressure Monitoring
Central Venous
Pressure MonitoringBy: Kris Lyn L. Tejerero
Central Venous Pressure (CVP) Is the pressure in the
vena cava or right atrium
CVP represents the driving force for filling the right atrium and ventricle
Is used to assess right ventricular function and venous blood return to the right side of the heart
Central Venous Pressure (CVP) CVP can be continuously
measured by connecting either a catheter positioned in the vena cava or the proximal port of pulmonary artery to a pressure monitoring system
Patient’s in general medical-surgical units who require CVP monitoring may have single-lumen or multilumen catheter placed in the superior vena cava.
Central Venous Pressure (CVP) Intermittent measurement of
the CVP can then be obtained with the use of water manometer.
CVP can also be seen as a measurement of preload on the right side of the heart.› Preload – is the amount of
blood presented to the heart or when the ventricle is full before the next ejection. Preload is the right ventricle end-diastolic pressure.
Normal CVP pressure is 2 to 6 mm Hg. › Other book/source: 2 - 12 mm Hg or 4
- 10 mm Hg
Purpos
e To serve as a guide to fluid
replacement in seriously ill patients.
To estimate blood volume deficits.
To determine pressures in the right atrium and central veins.
To evaluate for circulatory failure (in context with total clinical picture of patient)
For drug administration (long term chemotherapy)
To serve as a route for hyper alimentation.
recorded at the end of expiration
measured by transducing the waveform of a central venous line
electronic transducer placed & zeroed at the level of the RA (the “phlebostatic axis” – usually the 4th intercostal space in the mid-axillary line is used)
MEASUREMENT
Vascular access Total parenteral nutrition Infusion of irritant drugs Measurement of central
venous pressure Cardiac catheterization Pulmonary artery
catheterization Trans venous cardiac
pacing. Hemo dialysis Hemodynamic monitoring
INDICATIONS
Do not insert into an infected area.
Avoid infraclavicular approach to subclavian vein if patient has apical emphysema or bullae.
Avoid internal jugular vein if carotid aneurysm present on the same side.
Bleeding diatheses Septicaemia Hypercoagulable states
CONTR
A-
INDIC
ATIO
NS
COMMON COMPLICATIONS
Infection Air Embolism
A drop in CVP indicates decreased in circulating volume w/c may result from:
Fluid Imbalance Hemorrhage Severe vasodilatation Pooling of blood in the extremities
with limited venous return
A rise in CVP indicates an:
Increase blood volume because of a sudden shift on fluid balanceExcessive Iv infusionRenal FailureSodium or water retention
IMPORTANCE OF CVP MONITORING
CVP catheter is inserted, it is secured and dry, sterile dressing is applied. Rationale: Sterile procedure and dressing prevents blood stream infections.
Catheter placement is confirmed by a chest x-ray and the site is inspected daily for signs of infection. Rationale: Chest x-ray can detect malpositions of the catheter. To prevent wound infection.
NURSING INTERVENTIONS
CVP catheter can be used for infusing IV fluids, administering IV medications and drawing blood specimens in addition to monitoring pressure.
To measure CVP, the transducer must be placed must be placed at a standard reference point called the phlebostatic axis. And CVP can be measured correctly with the patient supine and backrest position up to 45 degrees. Rationale: Reduces risk of air embolism during insertion And CVP can be measured correctly with the patient supine and backrest position up to 45 degrees.
NURSING
INTERVENTIONS
Normal CVP Monitoring CVP WAVEFORM ANALYSIS
› Dominant a wave – pulmonary hypertension,
› Cannon a wave – complete heart block, (VT) ventricular tachycardia with AV dissociation
› Dominant v wave – (TR) Tricuspid Regurgitation
› Absent x descent – (Af) Atrial Fibrilation› Exaggerated x descent – pericardial
tamponade, constrictive pericarditis› Sharp y descent – severe TR, constrictive
pericarditis› Slow y descent – TR, atrial myxoma› Prominent x and y descent – Right
Ventiricle (RV) infarction
The End
THANK
YOU