CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
1. Central venous pressure (CVP) describes the pressure of blood in the
thoracic vena cava, near the right atrium of the heart. CVP reflects the
amount of blood returning to the heart and the ability of the heart to
pump the blood into the arterial system.
2. This is inserted by a physician when the patient needs more intensive
cardiovascular monitoring.
3. The normal CVP value is 5-12 cm H2O or 2-6 mm/Hg.
CENTRAL VENOUS PRESSURE MONITORING
PURPOSE:
1. To serve as a guide for fluid replacement
2. To monitor pressures in the right atrium and central veins
3. To administer blood products, total parenteral nutrition and drug
therapy contraindicated for peripheral infusion.
4. To obtain venous access when peripheral vein sites are inadequate
5. To obtain central venous blood sample
CENTRAL VENOUS PRESSURE MONITORING
CAUSES OF ELEVATED CVP
1. Overhydration which increases venous return.
2. Heart failure or Pulmonary artery stenosis which limit venous
outflow and lead to venous congestion.
3. Cardiac tamponade
4. Pleural effusion
5. Tension pneumothorax
CENTRAL VENOUS PRESSURE MONITORING
CAUSES OF DECREASED CVP
1. Hypovolemic shock from hemorrhage, fluid shift, dehydration.
2. Negative pressure breathing which occurs when the patient
demonstrates retractions or mechanical negative pressure which is
sometimes used for high spinal cord injuries.
3. Forced inhalation
CENTRAL VENOUS PRESSURE MONITORING
SITES FOR CVP ACCESS
▪ Basilic (arm) vein
▪ Femoral vein
▪ Subclavian vein
▪ External jugular vein
▪ Internal jugular vein
CENTRAL VENOUS PRESSURE MONITORING
Equipment:
1. CVP Kit
2. Flush system composed of intravenous solution [ contain heparin],
tubing, stopcocks and flush device
3. Pressure bag place around the flush solution is maintained 300
mmHg pressure, pressurized flush system delivers 3 to 5 ml
solution per hours through catheter to prevent clotting.
4. Transducer to convert the pressure from right atrium into electrical
signal.
5. Monitor which increase size of signal for display on oscilloscope
6. IV Pole
CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
Assessment
1. Evaluate client's understanding and Determines how the procedure will be
cooperation during the procedure. carried out
2. Determine baseline vital signs. Allows detection of potential
complications
3. Assess patency of central venous
catheter.
4. Assess previous measurement to
determine trend pattern
5. Assess the working area it is well Determines what preparation needs to be
lit. done to ensure a successful procedure.
6. Watch for indications of distress or To determine what teaching or support are
embarrassment needed
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
PLANNING
1. Prepare all the materials and
supplies needed for the procedure
a. CVP Kit
b. Flush system composed of
intravenous solution [
contain heparin], tubing,
stopcocks and flush device.
c. Pressure bag place around Organized materials facilitate easy
the flush solution is access during the procedure.
maintained 300 mmHg
pressure, pressurized flush
system delivers 3 to 5 ml
solution per hours through
catheter to prevent clotting.
d. Transducer to convert the
pressure from right atrium
into electrical signal.
e. Monitor which increase size
of signal for display on
oscilloscope
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
1. Identify client and explain the purpose Alleviates anxiety and gains the
of doing the procedure and obtain cooperation of the client.
inform consent.
a. Explain to client how to perform The Valsalva maneuver performed
Valsalva maneuver. during catheter insertion and removal
b. Client must NPO 6 hours before decreases chance of air embolism.
the procedure.
2. Provide privacy by closing the Protects client’s dignity.
windows and doors.
3. Set the bed to a comfortable height to Promotes proper body mechanics and
work and raise the side rail on the ensures client safety.
opposite side.
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
2. Wash hands. Deters the spread of microorganisms.
3. Assist the client to an appropriate Provides for maximum visibility of
position: veins.
a. Place in supine position:
5.1.1 Arm Veins: Extend arm and
secure arm board.
5.1.2 Neck Veins: Place patient in
Trendelenburg’s position. Place a Trendelenburg’s position prevents
small rolled towel under shoulders chance of air emboli. Anatomic access
(subclavian approach) and clinical status of the patient are
considered in the site selection.
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
To measure CVP
2. Place the patient in supine position Facilitates proper position for accurate
insertion of the device and used for
subsequent readings.
3. Position the zero point of the
manometer should be on level with the
patient right atrium.
4. Turn the stopcock so the IV solution
flows into the manometer, filling about
20-25 cm level then, turn the stopcock
so solution in manometer flows into
the patient.
CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
To measure CVP
2. Observe the fall I the height of the The column of the fluid will fall until it
column of fluid in the manometer. meets an equal pressure (i.e., the
Record the level at which the solution patient’s central venous pressure) The
stabilizes or stops moving downward. CVP reading is reflected by the height of
This is the central venous pressure. a column of fluid in the manometer when
Record CVP and the position of the there is open communication between
patient. the catheter and the manometer. The
fluid in the manometer fluctuate slightly
with the patient’s respirations. This
confirms that the CVP line is not
obstructed by the clotted blood.
3. The CVP catheter may be connected to
a transducer and an electrical monitor
with either digital or calibrated CVP
wave readout.
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
To measure CVP
2. The CVP may range from 5 to 12 cm The change in CVP is a more useful
H2O (absolute numeric value has not indication of adequacy of venous blood
been agreed on) or 2 to 6 mm Hg. volume and alterations of cardiovascular
functions. The management of the
patient is not based on one reading, but
on the repeated readings in correlation
with patient’s clinical status.
3. Assess the patient’s clinical condition. CVP is interpreted by considering the
Frequent changes in measurements patient’s entire clinical picture, hourly
(interpreted within the context of the urine output, heart rate, blood pressure,
clinical situation) will serves as a guide cardiac output measurements.
to detect whether the heart can handle
its fluid load and whether hypovolemia
is present.
4. Turn the stopcock again to allow IV When readings are not being made, flow
solution t floe from solution bottle into is form a very slow micro drip to the
the patient’s vein. catheter, bypassing the manometer.
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
To measure CVP
Follow- up Phase
2. Observe for complications The patient complaints of new or
different pain or shortness of breath must
be assessed closely; may indicate
development of complications.
a. From catheter insertion site: a. Signs/ symptoms of air
Pneumothorax, hemothorax, air embolism include severe
embolism, hematoma and cardiac shortness of breath, hypotension,
tamponade. hypoxia, rumbling murmur and
b. From indwelling catheter: cardiac arrest.
Infection, air embolism
c. If air embolism is suspected,
immediately place patient in a left
lateral Trendelenburg’s position
and administer oxygen. Air
bubbles will be prevented from
moving into the lungs and will be
absorbed in 10 to 15 minutes in
the right ventricular outflow tract.
CENTRAL VENOUS PRESSURE MONITORING
Steps Rationale
IMPLEMENTATION
To measure CVP
Follow- up Phase
2. Carry out ongoing nursing surveillance
of the insertion site and maintain
aseptic technique.
a. Inspect entry site twice daily for
signs of local inflammation/
phlebitis. Remove immediately
if there are any signs of
infection.
b. Change dressing as prescribed
c. Label to show date/time of
change
d. Send the catheter tip for
bacteriologic culture when it is
removed.
CENTRAL VENOUS PRESSURE MONITORING
EVALUATION
Assess for the color, odor, and amount of urine. Note for any complaints for pain on the
catheter site.
Document the procedure done including all the assessment findings.
Video Link
https://youtu.be/HbGW3sjlJTk
https://youtu.be/M-0MDLW_eBw
