Sub - Medical Surgical Nursing
Assignment on CVP Monitoring
Submitted To: Submitted By:
Ms Anjali kamini
Nursing Lecturer msc (N) 1st yr
PIPRAMS PIPRAMS
Submitted on : 27/April/2021
Introduction -
Central venous pressure measurement is often associated with intensive and critical care settings. However,
with increasing numbers of critically ill patients being cared for on medical and surgical wards, it is essential
that clinicians are able to record central venous pressure measurement accurately and recognisenormal and
abnormal parameters.
Reasons for measuring CVP -
Circulating blood flows into the right atrium via the inferior and superior vena cava. The pressure in the right
atrium is known as central venous pressure (CVP). The condition of the patient and the treatment being
administered determine how often CVP measurement should take place, for example, critically ill unstable
patients may need hourly measurements.
Measuring central venous pressure -
CVP is measured using an indwelling central venous catheter (CVC)
and a pressure manometer or transducer. Both methods are
reliable when used correctly.
Wards generally use manometers.
Equipment: transducers
Accident and Emergency departments, High Dependency areas and Intensive Care units use transducers for
measuring CVPs.
TransducedCVP waveform
Insertion sites
CVC insertion sites include:
•Internal jugular vein
•Subclavianvein
•Femoral vein
Measuring central venous pressure-
Internal jugular veins-
This site is chosen frequently as there is a high rate of successful insertion and a low incidence of
complications such as pneumothorax. Internal jugular veins are short, straight and relatively large allowing
easy access, however, catheter occlusion may occur as aresult of head movement and may cause irritation in
conscious patients.
Subclavianveins-
This site is often chosen as there are more recognisableanatomical landmarks, making insertion of the device
easier. Because this site is positioned beneath the clavicle there is a risk of pneumothoraxduring insertion. A
subclavianCVC is generally recommended as it is more comfortable for the patient.
Femoral veins
This site provides rapid central access during an emergency suchas a cardiac arrest. As the CVC is placed in a
vein near the groin there is an increased risk ofassociated infection. In addition, femoral CVCsare reported to
be uncomfortable and may discourage the conscious patient from moving.
CVP recording -
CVP is usually recorded at the mid-axillaryline where the manometer arm or transducer is level with the
phlebostaticaxis. This is where the fourth intercostalspace and mid-axillaryline cross each other allowing the
measurement to be as close to the right atrium as possible.
Using a menometer-
. Explain the procedure to the patient to gain informed consent.
If IV fluid is not running, ensure that the CVC is patent by flushing the catheter.3.
Place the patient flat in a supine position if possible. Alternatively, measurements
can be taken with the patient in a semi-recumbent position. The position should
remain the same for each measurement taken to ensure an accurate comparable
result.
Measuring central venous pressure -
4
Line up the manometer arm with the phlebostaticaxis
ensuring that the bubble is between the two lines of the
spirit leve
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'.Open the IV
fluid bag and slowly fill the manometer to a level
higher than the expected Using a 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
Measuring central venous pressure -
Interpreting measurements
The normal range for CVP is 5-10cm H2O (2-6mmHg) when taken from the mid-axillaryline at the fourth
intercostalspace.
Many factors can affect CVP, including vessel tone, medications,heart disease and medical treatments. A CVP
measurement should be viewed in conjunction with other observations such as pulse, blood pressure and
respiratory rate and the patients response to treatment.
Potential complications -
Haemorrhage -from the catheter site -if it becomes disconnected from the infusion. Patients who have
coagulation problems such as those on warfarinor those will clotting disorders are at risk
.Catheter -occlusion, by a blood clot or kinked tube -regular flushing of the CVC line and a well secured
dressing should help to avoid this.
Infection-redness, pain, swelling around the catheter insertion site may all indicate infection. Careful asepsis is
needed when touching a CVC site. Swabs for MC&S should be taken if infection is suspected.
Air embolus-if the infusion or monitoring lines become disconnected there is a risk that air can enter the
venous system. All lines and connections should be checked at the start of every shift to minimisethe risk of this
occurring.
Catheter displacement-if the CVC moves into the chambers of the heart then cardiac arrhythmias may be
noted, and should be reported. If the CVC is no longer in the correct position, CVP readings and medication
administration will be affected.
References-
Cole E (2007) Measuring central venous pressure.Nursing Standard. 22 (7) 40-42Hamilton H(2006a)
Complications associated with venous access devices: part one. Nursing Standard.20, 26, 43-50.
Hamilton H(2006b) Complications associated with venous access devices: part two. Nursing
Standard.20, 27, 59-65.
Jevon P, Ewens B (Eds)(2007) Monitoring the Critically Ill Patient.Second edition. Blackwell Science,
Oxford.
Morton PG, Fontaine DK, Hudak CM, Gallo BM(2005) Critical Care
Nursing: a Holistic Approach.Eighth edition. Lippincott Williams and Wilkins, Philadelphia PA.
National Institute for Clinical Excellence(2002) Central Venous Catheters: Ultrasound Locating
Devices.Technology appraisal No. 49. NICE, London.
Wiklund CU, Romand JA, Suter PM, Bendjelid K(2005) Misplacement of central vein catheters in
patients with hemothorax: a new approach to resolve the problem. Journal of Trauma.59, 4, 1029-1031.
Woodrow P(2002) Central venous catheters and central venous pressure. Nursing Standard.16, 26, 45-
51.
