Central venous pressure monitoring

CVP is the one of invasive hemodynamic monitoring through insertion . of the catheter in large vein to right atrium to provide a good assessment of right- sided cardiac function and venous. return to the right side of the heart The CVP are indirect method to determining right ventricles filling .[pressure[ preload This is inserted by a physician when the patient needs more intensive .cardiovascular monitoring .Normal CVP is 5-12cm H2Oor 2-6mmHg : CVP is elevated by .overhydration which increases venous returnheart failure or PA stenosis which limit venous outflow and lead to .venous congestion .positive pressure breathing, straining:CVP decreases with .hypovolemic shock from hemorrhage, fluid shift, dehydrationnegative pressure breathing which occurs when the patient demonstrates retractions or mechanical negative pressure which is sometimes used for .high spinal cord injuries

: Description
The catheter is usually held in place by a suture or staple and an occlusive dressing. Regular flushing with saline or a heparin-containing solution .keeps the line patent and prevents infection

: Purposes
. a. To serve as guide for fluid replacement .b. To monitor pressure in the right atrium and central veins c. To administer blood products, TPN and drug therapy contraindicated . for peripheral infusion .d. To obtain venous access when peripheral veins sites inadequate . e. To insert a temporary pacemaker . f. To obtain central venous blood sampler :Possible cannulation sites for central venous access include Basilic (arm) vein Femoral vein Subclavian vein External jugular vein Internal jugular vein

:Equipment
CVPkit-1

Flush system composed of intravenous solution [ contain -2 heprain],tubing ,stopcocks and flush device Pressure bag place around the flush solution is maintained 300 mmgh -3 pressure , pressurized flush system delivers 3 to 5 ml solution per hours . through cathter to prevent clotting Transducer to convert the pressure from right atrium into electrical -4 .signal . Monitor which increase size of signal for display on oscilloscope-5 .IV pole -6

: Monitoring CVP
.Pressure monitoring system -1 .Water manometer system -2

: Procedure guidelines Nursing action

Rationale

( Preparatory phase ( by the nurse . Explain the procedure to patient -1 . Position patient appropriately -2 Place patient in supine position . -Provides for maximum .visibility of veins Neck veins place in - To reduces risk of air .trendelenburg,s position . emboli Flush IV infusion set and manometer -3 or prepare heparin flush for use with transducer . Secure all connections . to prevent air emboli and bleeding

( Procedure: ( continued
Nursing action Rationale a. Attach manometer to IV pole .The - The level Rt atrium is at 4th zero point of the manometer should intercostals space midaxillary .be on level with the patient right atrium. Line b. Zero transducer & level port with pt .right atrium Place ECG monitoring. 4-Dysrhythmias may be -4 .noted during insertion ( Insertion phase : ( by physician The CVP site is surgically cleaned . 1- CVP insertion is a sterile -1 .procedure Assist the patient to remaining -2 . motionless during insertion Monitor for dysrhythmias , 3- indicted for signs of -3 .tachypnea, tachycardia as catheter pneumothorax or arterial puncture threaded to great veins . is . connect primed IV tubing to 4- To keep the vein open -4 catheter and allow IV solution . to flow .The catheter should be suture 5- To prevent dislodgement -5 . in place Place a sterile occlusive -6 .dressing over site Obtain a chest x-ray. 7- Verifies correct catheter -7 placement and absence of . pneumothorax To measure CVP . Place the patient in supine position -1 Position the zero point of the manometer should -2 .be on level with the patient right atrium

(..Procedure guideline : ( cont Nursing Action Turn the stopcock so the IV solution -3 flow into manometer ,to about 20 25 cm level . And the turn stopocock so the solution .in manometer flow to the patient Record the level the at which the -4 solution stabilizes .this CVP reading . CVP catheter connect to transducer -5 and electrical monitor with CVP wave . readout

Rationale

CVP may range from 5 to 12 cmH2O 6- Any changes indicate of -6 or 2 to 6 mm Hg. Adequate venous blood volume and alteration of cardiovascular . function . Assess patient condition -7 Turn the stopcock again to allow IV 8- To keep vein open and -8 . solution to follow to patient veins and prevent fluid overload . should monitor infusion hourly

: follow up phase
. Prevent and observe for complication -1 . a. From catheter insertion : pneumothorax hemothorax , air embolism . hematoma .and cardic temponade , b. From indwelling catherer : infection .air embolism, central venous thrombosis Make sure cap is secure on the end of 2- Reducing risk of air embolus -2 the CVP monitor and all clamps are close .when not in use If air embolism is suspected , 3- To prevent air bubbles from -3 immediately place patient in left lateral moving into lungs and will trendelenburg position and administer absorbed in 10 to 15 minutes in .O2. right ventricular outflow tract

(..Procedure guideline : ( cont

Nursing Action Rationale Carry out ongoing nursing -4 intervention of the insertion site .and maintain aseptic technique a. Inspect site twice daily for signs of a. Local infection may lead . local inflammation and phlebitis . to systemic infection Remove the catheter immediately . if there are signs of infection b. Make sure sutures are intact . b .if catheter dislodges into right atrium , dysrhythmias may .result .c. Change dressing as prescribed .d. label to show date and time of change e. Send the catheter tip for bacteriological e. To detect bacterial .culture when removed. colonization When discontinued , remove -5 .central line a. Position patient flat with head down. .entering blood vessel .b. Remove dressing and suture c. Have patient take deep breath and hold it while catheter is removed. .pressure .d. Apply pressure at catheter site .and apply dressing e. Monitor site and vital signs for signs of bleeding or hematoma .formation

a. Prevents air from c. Prevents air emboli by creating positive chest d. To prevent bleeding

: References Suzanne C.Semltzer,Brenda G.bare,(2004), Textbook Medical surgical -1 .( nursing ( 10th edition Lippincott Williams & Wilkins, ( 2006 ), Manual nursing practice ( 8th -2 .( edition