CENTRAL VENOUS PRESSURE LEARNING OUTCOMES By the end of this session the student should be able to :...
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Transcript of CENTRAL VENOUS PRESSURE LEARNING OUTCOMES By the end of this session the student should be able to :...
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CENTRAL VENOUS PRESSURE
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CENTRAL VENOUS PRESSURE
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CENTRAL VENOUS PRESSURE
LEARNING OUTCOMES
By the end of this session the studentshould be able to :
• Explain the indications for a patient requiring CVP monitoring
• Identify the equipment required for commencing CVP monitoring
• Describe the nursing role, both in the
care and use of the central venous monitoring line
• Discuss the reasons for abnormal CVP readings.
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CENTRAL VENOUS PRESSURE
DEFINITION
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
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CENTRAL VENOUS PRESSURE
PURPOSE
• 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
• To determine the function of the right
side of the heart
• To assist in monitoring circulatory failure
• None of these variables are measured directly; they must be interpreted.
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CENTRAL VENOUS PRESSURE
Axillary veinCephalic vein
Median cubital vein
Basilic vein
ACCESS
External Jugular vein
Subclavian vein
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CENTRAL VENOUS PRESSURE
COMPLICATIONS
• Carotid Artery Puncture
• Pneumothorax
• Air Embolism
• Arrhythmia
• Perforation of SVC or R. Atrium/Ventricle
• Infection
• Pleural Effusion
• Extravasion
• Allergic reaction to catheter material
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CENTRAL VENOUS PRESSURE
EQUIPMENT
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).
a.
b.
c.
d.
e.
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CENTRAL VENOUS PRESSURE
EQUIPMENT
IV extension set to entry port of patients central line.
IV giving setto fluid bag.
Stopcock(Three way tap)
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CENTRAL VENOUS PRESSURE
-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.
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CENTRAL VENOUS PRESSURE
DIRECTION OF FLOW
-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.
a. c.b.
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CENTRAL VENOUS PRESSURE
-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.
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CENTRAL VENOUS PRESSURE
-Then turn the knob toward the fluids (c).
-The level of fluid in the manometer will fall (the fluid is running into the patient's catheter) until the height of the fluid column exerts a pressure equivalent to the patient's central venous pressure. -The top of the fluid column will slightly oscillate up and down.
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CENTRAL VENOUS PRESSURE
-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.
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CENTRAL VENOUS PRESSURE
POSITION OF PATIENT
3-way tap
manometer
FluidBag
Patient in supine position
CentralVenousAccess
phlebostatic axis
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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)
• Several measurements are required to identify a trend
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CENTRAL VENOUS PRESSURE
DETERMINANTS
Cardiac Competence(reduced ventricular function raises CVP)
Blood Volume(increased venous return raises CVP)
Intra Aortic &Intra Peritoneal
Pressure(raises CVP)
Systemic Vascular Resistance
(raises CVP)
CVP
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CENTRAL VENOUS PRESSURE
REFERENCES
Henderson N., (1997) Central Venous Lines Nursing Standard 11:42, pp49-56
Mallett J., (2000) The Royal Marsden NHS TrustDougherty L., Manual of Clinical Nursing
Procedures, Fifth Edition Oxford; Blackwell Science,
pp630-635.
Mc Dermott M., (1995) Central Venous Pressure Nursing Standard 9:35, pp54
Nursing Standard., (1999) Quick Reference Guide 6.Central Venous Lines
Nursing Standard 13:42.
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CENTRAL VENOUS PRESSURE