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Blood from the systemic veins flows into the right atrium. The pressure in the right atrium is the CVP. A catheter is passed via; the subclavian vein or jugular vein into the superior vena cava
to determine the venous return and intravascular volume of the right atrium.
The normal value is 6-12cm H2O
To serve as a guide of fluid balance in critically ill patients (To guide the administration of fluid or diuretics.) To estimate the circulating blood volume
Cephalic vein
Basilic vein
CENTRAL VENOUS PRESSURE COMPLICATIONS Carotid Artery Puncture Pneumothorax Air Embolism
Arrhythmia
Perforation of SVC or R. Atrium/Ventricle Infection Pleural Effusion Extravasion
a.
d. b. e.
c. The equipment needed for measurement of central venous pressure includes a sterile bag of fluids (a) with attached fluid administration set (b), an IV extension set (c), a manometer (d) and a stopcock (e).
IV extension set to entry port of patients central line. Stopcock (Three way tap)
-Patient Preparation:
*Place the patient in the supine position with the head of the bed flat. *Locate and mark the phlebostatic axis with the skin marker.
b.
c.
-The white arrows indicate the direction of fluid flow. -Initially the white knob is turned straight up towards the manometer, allowing fluid to flow from the fluid bag to the patient's catheter to assure the catheter is patent (a). -If fluid does not flow freely into the patient's catheter a valid CVP reading will not be obtained.
-Then the knob is turned toward the patient (b) and fluid will fill the manometer.
-The manometer should not contain any air bubbles. -If air is present in the manometer or fluid line, let the fluids run, overfilling the manometer until all air is purged from the system.
-Take the CVP reading when the fluid level stabilizes at the end of expiration. -Turn the stopcock off to the manometer and run the IV fluids through the central venous line as prescribed. Post care: Patient: Return the patient to correct position. Nurse: Handwash. Environment: Return equipment. Documentation: Document the reading.
Fluid Bag
phlebostatic axis
CENTRAL VENOUS PRESSURE INTERPRETATION An increase of above normal may indicate weakening or failure of the right side of the heart, or excessive intravascular volume A pressure below 5cm H2O usually reflects an intravascular volume deficit or drug induced excessive vasodilation CVP measurements must not be interpreted on their own, but viewed alongside the patient's full clinical picture
(BP, Respiratory Pattern, Colour, Temperature)
CVP
Henderson N.,
(1997)
Central Venous Lines Nursing Standard 11:42, pp49-56 The Royal Marsden NHS Trust Manual of Clinical Nursing Procedures, Fifth Edition Oxford; Blackwell Science, pp630-635. Central Venous Pressure Nursing Standard 9:35, pp54 Quick Reference Guide 6. Central Venous Lines Nursing Standard 13:42.
(2000)
Mc Dermott M.,
(1995)