Central Venous Pressure

Central Venous Pressure

CVP
Refers to the
measurement
of right atrial pressure
or the pressure
of the great veins
within the thorax.

Central Venous Pressure

CVP
Obtained by inserting a catheter
into the external jugular,
antecubital or
femoral veins and
threading it into the vena cava.
The catheter is attached to an IV infusion
and water manometer by a
3 way stopcock.

Central Venous Pressure

CVP
Indications:
Hypervolemia (above 10 cm H2O)
Hypovolemia (below 4 cm H2O)
Hemodialysis (decreased due to rapid
removal or ultrafiltration of fluid from the
intravascular)
Congestive Heart Failure (elevated CVPRSHF)

Central Venous Pressure

CVP
Purposes:
To serve as guide for fluid replacement
To monitor pressure in the right atrium and central
veins
To administer blood products, total parenteral
nutrition, and drug therapy contraindicated for
peripheral infusion)
To obtain venous access when peripheral vein sites
are inadequate
To insert a temporary pacemaker
To obtain central venous blood samples

Central Venous Pressure

CVP
Vein Used:
Subclavian vein

Jugular vein

Femoral vein
(emergencies
situation)

CVP
Nursing Care
Ensure patient is relaxed.
Maintain zero point of manometer always
at level of right atrium (midaxillary line).
Determine the patency of catheter by
opening IV infusion line.
Turn the stopcock to allow IV solution to
run into the manometer to a level of 10-20
cm above expected pressure reading.

CVP
Nursing Care
Turn the stopcock to allow IV solution to flow
from manometer into catheter, fluid level in
manometer fluctuates with respiration.
Stop ventilatory assistance during measurement
of CVP.
After CVP reading, return the stopcock to IV
infusion position.
Record CVP reading and position the patient.

CVP
Knowledge
Assesses patient and evaluates
PT, PTT and CBC.

To assess for the coagulation time or anemia

Checks the doctors order for

insertion of a central IV line with
CVP manometer.

To avoid mistakes

Explains the procedures to the

patient, state the purposes and
obtain informed consent.

To ensure cooperation of the patient, and serve as

legal document

CVP
Knowledge
Explains to patient how to
perform the Valsalva maneuver.
To decrease chance of air embolism

Places patient on NPO for 6

hours prior to insertion of CVP.
To minimize hazards of vomiting and
aspiration

CVP
Knowledge
Assembles the following
equipments/supplies accordingly.
To facilitate intervention

Gown, mask, caps and sterile

gloves
Venous pressure tray and
Cutdown tray
Infusion solution and Infusion
set
CVP manonmeter and 3 way
stop cock
Arm board, sterile dressing and
tape
Syringe (3cc) and Heparin
(flush system)
ECG monitor

CVP
Knowledge
Positions the patient
appropriately:
Arm vein place patient in
supine and extend arm, then
secure arm board
For maximum visibility of vein

Neck vein place patient on Tposition, place a small rolled

towel under shoulders.
(subclavian approach)
T-position dilates veins through slight
positive pressure introduced in the central
veins and prevents chance of an emboli.

CVP
Knowledge
Flushes IV infusion set and manometer.
Secure all connections to prevent air
emboli.
Attached manometer to IV pole. The
zero point of the manometer should be
on a level with the patients right atrium.
The level of the right atrium is in the 4th
intercostal space mid axillary line

Calibrate at zero level port with patients

right atrium
Mark mid axillary line with indelible ink for
subsequent readings to ensure consistency of
the zero level.

CVP
Knowledge
Places patient on ECG monitor.
Dysrhythmias may be noted during insertion as catheter is
advanced

CVP
Skills (Insertion Phase)
Physician dons cap, mask and gown.
CVP insertion is a sterile procdure.

CVP site is surgically cleaned. CVP catheter

is introduced percutaneously or by direct
venous cut down.
To prevent infection.

Patient may be asked to perform Valsalva

maneuver and assist to remain motionless
during insertion.
To protect against chance of air embolism.

CVP
Skills (Insertion Phase)
Connects IV tubing / heparin flush system to
catheter and allow IV solution to flow at a
minimum rate to KVO (max. of 25 ml)
Catheter placement must be verified before hypertomic solution of blood
product can be administered. Heparin is an anticoagulant.

The catheter is sutured in place and sterile

occlusive dressing over the site applied.
To prevent accidental pulling of catheter and maintai sterility of the incision
site.

Do a chest x-ray
To verify correct catheter position.

CVP
Skills (CVP Measurement)
Places the patient in a comfortable position.
To faciliate easy measurement and to avoid error reading

Positions the zero point of the manometer at the

level of the right atrium.
This is the baseline position used for subsequent reading and measurement

Turn the stop cock so that the IV solution flows

into the manometer, filling about 20-25 cm H2O
level. Then turn stopcock so solution in
manometer flows into the patient.
To measure CVP

CVP
Skills (CVP Measurement)
Observes fluctuation of liquid in the manometer
and record the level at which the solution stabilizes
or stop moving downward. This is CVP reading
(Normal reading 4-10 cm H2O 4-12 in other
books).
The solution in the manometer will fall until it meets an euqal pressure.

Turn the stop cock again to allow IV solution to flow

from solution bottle into the patients vein. Position
the patient comfortably.
When the reading are not being made, flow is from a very slow microdrip to the
catheter, bypassing the manometer to prevent blood clot formation in the IV
tubing.

CVP
Skills (CVP Measurement)
Washes hands and record CVP reading.
The change in CVP is a more useful indication of adequacy of venous
blood volume and alteration in cardiovascualr function. The
management of the patient is not based on one reading but on serial
readings in correlation with patients clinical status.

CVP
Skills (Follow Up Phase)
Assesses the patients clinical conditions
and observe for complications.
From catheter insertion
Pneumothorax, hemothorax and air embolism
Air bubbles will be prevented from moving into the lung and will
be absorbed in 10-15 minutes in he right ventricular outflow
tract

From indwelling catheter

Infection and air embolism

CVP
Skills (Follow Up Phase)
Carries out ongoing surveillance of the
insertion site and maintain aseptic
technique.
Inspect entry site 2x daily for signs of local
inflammation/phlebitis.
Label to show date/time of change
Change dressing as prescribed
Send the catheter tip for bacteriologic culture when it
is removed and check catheter tip for completeness.

-Thank You for Listening-