Central Venous Pressure Measurement

 

N - 112 MS 1 RLE CENTRAL VENOUS PRESSURE MEASUREMENT

Meaning and Purposes • It is the pressure within the right atrium Purposes 1. Determine the pressure in the right atrium 2. Assess the preload of the right side of the heart 3. Guide to uid replacement 4. Esmate the circulang blood volume Indicatons of CVP  For patens wih: 1. Congesve heart failure 2. Decrease in myocardial contraclity 3. Renal failure 4. Tension Pneumothorax 5. Pleural eusion 6. Hypovolemia or Hypervolemia 7. Decrease in myocardial contraclity 8. Decreased cardiac output

Inerpreaton of CVP  • An increase above normal or elevaed CVP  results indicate weakening or failure of the right side of the heart or excessive uid blood volume • A pressure below normal  reects an intravascular  blood volume decits or drug-induced excessive vasodilaon • CVP measuremen mus no be inerpreed on heir own, but viewed alongside the paent’s full clinical picture (BP, respiratory paer, color, temperature)

Normal Value and Caheer Placemen  • Normal CVP ranges from 4 to 12 mm Hg (ref. Brunner) or 5 – 10 cm H2O Veins Sies for Caheer Placemen  1.Cephalic or basilic 2.Subclavian 3.External or internal jugular

Maerials Needed for CVP Measuremen  Measuremen  1.Sterile bag of uid – normal –  normal saline soluon (isotonic) 2.Administraon set 3.IV extension set 4.CVP Manometer 5.Stopcock

Nursing Care of CVP  1. Hand hygiene 2. Sterile technique when changing the central line dressing 3. Change gauze every 48 hours; transparent dressing every 7 days 4. Wearing clean gloves before accessing the line port 5. Performing a 15 – 30 second “hub scrub” using fricon in a twisng moon 6. Ansepc-containing port protectors to cover connectors 7. Assess catheter site

 

Skill 9: CVP Measuremen Measuremen    1. 1.Informs Informs paent of the procedure. 2.Washes hands 3.Provides 3. Provides for  for client’s privacy  4. 4.Places Places the client in supine posion (if posion (if contraindicated, adjusts the posion). 5.Places 5. Places the manometer  at  at zero level adjacent to the 5th ICS midaxillary line. 6.Opens 6. Opens the CVP and IV port and closes and closes paent's Port

11.Makes 11.Makes sure no air has entered the IV line during line during reading. Closes the CVP line and opens the IV  line to allow uid to ow to the paent's line for ushing. 12.Reaaches 12.Reaaches venlator  if  if the paent is on venlator. Reposions paent. 13.Regulates 13.Regulates IV uid  as  as previously ordered. 14.Washes 14.Washes hands.  hands. 15.Documents 15.Documents the  the CVP reading, condion and posion of client when CVP reading was obtained.

7. Allows IV soluon to ow to the CVP line to 7. Allows line to about 20 - 25 cm. level at the manometer 8.Closes 8. Closes the IV line and line and opens CVP line and  paent's line. 9.Instructs 9. Instructs paent  to  to take a deep breath and observes for uid uctuaon (In case intubated and conscious, detaches paent from the venlator temporarily and asks paent to take a deep breath; if intubated and unable to follow commands, observes uid uctuaon at the end of inspiraon). 10. 10.Notes Notes the  the level where the uctuaon stabilizes.