CENTRAL VENOUS PRESSURE MONITORING Indications: CVP measurement Drug and fluid administration Nutrition and feeding Cardiac

diac pacing

Other Indications: Fluid resuscitation in major trauma Cardiac surgery Thoracic surgery Major abdominal surgery To optimaize fluid replacement in acute renal failure To optimize fluid replacement during sepsis To guide fluid replacement in heart failure

Normal Values: CVP 2-6 mmHg

Insertion Sites: Internal jugular vein Subclavian vein Femoral vein Brachial vein

CVP is affected by: Intrathoracic pressure or musculoskeletal pump Vascular tone Obstruction

Special Considerations: Arrange for daily chest X-rays to check catheter placement, as ordered. Care for the insertion site according to facility policy. Change the dressing every 24 to 48 hours. Be sure to wash your hands before dressing changes; use aseptic technique and sterile gloves when redressing the site. When removing the old dressing, observe for signs of infection, such as redness, and note patient complaints of tenderness.

Apply ointment if directed by facility policy, then cover the site with a sterile gauze dressing or a clear occlusive dressing. After the initial CVP reading, reevaluate readings frequently to establish a baseline for the patient. Authorities recommend obtaining readings at 15-, 30-, and 60- minute intervals to establish a baseline. If the patients CVP fluctuates by more than 2 cm H2O, suspect a change in his clinical status and report this finding to the physician. Change the IV solution every 24 hours and the IV tubing every 48 hours, according to facility policy. Expect the physician to change the catheter every 72 hours. Label the IV solution, tubing, and dressing with the date, time, and your initials. Source: Nurses Quick Check: Skills, by Lippincott Williams & Wilkins, page 99.

Nursing Management: Zero the transducer before each reading (especially if the patients position has changed) to ensure accuracy of readings. Maintain volume in pressure bag by changing flush solution every 4 days or when bag empty and maintain pressure at 300mmHg to ensure patency of line and accurate waveform and measurement. Pressure bag and transducer set-up, administer fluid at 3mls/hr through attached catheter to maintain patency. The documented measurement should be the end-expiratory value as opposed to the mean. Perform routine CVP measurement hourly or more frequently if required. Complications: Injury during insertion Air embolus Infection Dislodgment Fluid overload Central vein thrombosis Low CVP reading is caused by: Hemorrhage Excessive dieresis- result of diabetes or diuretic therapy Poor venous return- eg. Cardiogenic shock Peripheral vasodilation- result of septicemia or vasodilatory therapy High CVP reading is caused by: Hypervolemia- occurs with excessive fluid infusion

Cardiac failure High blood viscosity- massive blood transfusion Lumen occlusion/obstruction- cannula might be kinked or resting against the vein wall, or the patient might have thrombus Artifact- caused by mechanical interference (eg. Viscous drugs or fluids remaining in the CVP line or in progress while CVP is being measured User error- air filter in the manometer can become wet