2. CVP
Central venous pressure (CVP) (also
known as: right atrial pressure; RAP)
describes the pressure of blood in the
thoracic vena cava, near the right atrium of
the heart
3. Normal CVP can be measured from
two points of reference:
•Sternum: 0–14 cm H2O
•Mid axillary line: 8–15 cm H2O
9. Indications
Long term intravenous antibiotics
Chemotherapy
Total paranteral nutrition
Dialysis
Monitoring CVP
Limited vascular access
Administering large amount of blood &
blood products.
10.
11.
12. Types Of Central Venous Catheters
Nontunneled central catheters
Tunneled central catheters
Peripherally inserted central catheters
(PICC)
Implantable ports
13. Nontunneled Central Venous
Catheters
Used for short-term therapy
Inserted percutaneously
Subclavian vein
Internal jugular vein
Femoral vein
Has from 1 to 4 lumens or ports
Usually from 6 to 8 inches in length
14.
15. Tunneled Central Venous
Catheters
Used for long term therapy
Inserted surgically
Small Dacron cuff sits in subcutaneous tunnel
Initially sutured but removed in 7 to 10 days
External portion of the cath can be repaired
18. Peripherally Inserted Central
Catheters (PICC)
Used for intermediate to long term therapy
May be single or double lumen
Inserted percutaneously
Basalicvein
Cephalic vein
Threaded into the superior vena cava
May be inserted by specially trained RN
19.
20. Implantable Ports
Used for long term therapies
Surgically implanted
Consists of metal or plastic housing
Silicone cath placed in superior vena cava
Dressing required until insertion site healed
23. For intermittent CVP
monitoring
Disposable CVP manometer set
leveling device (such as a rod from a reusable
CVP pole holder or a carpenter’s level or rule) ,
additional stopcock (to attach the CVP
manometer to the catheter)
25. Implementation
Gather the necessary equipment.
Explain the procedure to the patient to reduce his
anxiety.
Assist the physician as he inserts the CV catheter.
26. Complications
Infection
Phlebitis
Septicemia or pyrogenic reaction
Air embolism
Thrombosis/occlusion
Extravasations
pneumothorax
28. CVP monitoring helps
to assess cardiac function,
to evaluate venous return to the heart,
to indirectly know how well the heart is
pumping
29. To measure the patient’s volume status, a
disposable plastic water manometer is attached
between the I.V. line and the central catheter
with a three- or four-way stopcock.
CVP is recorded in centimeters of water (cm
H2O) or millimeters of mercury (mm Hg) read
from manometer markings.
30. MEASURING CVP WITH
A WATER MANOMETER
To ensure accurate (CVP) readings, make sure
the manometer base is aligned with the patient’s
right atrium (the zero reference point).
31. The manometer set usually contains a
leveling rod to allow you to determine this
quickly.
After adjusting the manometer’s position,
examine the typical three-way stopcock.
32. By turning it to any position shown at right,
you can control the direction of fluid flow.
Four-way stopcocks also are available
37. I.V.
solution
bottle
Manometer
Zero point
Three-way stopcock
38. Turn the stopcock off to the patient, and
slowly fill the manometer with I.V. solution until
the fluid level is 10 to 20 cm H2O higher than
the patient’s expected CVP value.
Don’t overfill the tube because fluid that spills
over the top can become a source of
contamination.
39. Turn the stopcock off to the I.V. solution and
open to the patient.
The fluid level in the manometer will drop.
When the fluid level comes to rest, it will
fluctuate slightly with respirations.
Expect it to drop during inspiration and to rise
during expiration.
Record CVP at the end of expiration, when
intrathoracic pressure has a negligible effect.
40. Depending on the type of water manometer
used, note the value either at the bottom of the
meniscus أسفل السطح المحدبor at the midline
of the small floating ball.
After you’ve obtained the CVP value, turn the
stopcock to resume the I.V. infusion.
Adjust the I.V. drip rate as required.
Place the patient in a comfortable position.
41. General Nursing Care Of Patient
With CVC
Before insertion, lines are initially
flushed with saline
During percutaneous insertion of CVC in
the subclavian or jugular, place patient in
Trendlenberg or have him perform
Valsalva maneuver
42. After insertion, an occlusive gauze or
transparent dressing is applied
Blood is aspirated through all lumens to
verify patency
Chest xray must be performed before use
43.
44. Flushing of lines
Each lumen is treated as a separate cath
Injection caps are vigorously cleaned with
alcohol
Use 10cc or larger syringe for administration
of meds or flush
Turbulent flush technique is recommended
45. Site assessment and determination of
external cath length is performed and
documented with each dressing change
Tubings are changed per protocol – 72hrs
Caps and connections are changed per
protocol – 3-7 days
46. When to call the physician
Temp of 100.5F or greater
Chills, dyspnea, dizziness
Pain, redness, swelling, or drainage at site
Unresolved resistance, pain or fluid leaking while
flushing
Hole or tear in cath
Excessive bleeding at site
Change in length of external cath
Swelling in neck, face, chest, or arm
47. General safety measures
No sharp objects near cath
Clamp cath when not in use
No pulling or tension on the cath
Activity limitations
48. Discontinuing A CVC
Follow the institution’s policy and procedure
For percutaneous internal jugular or subclavian
insertion sites, place patient in trendlenburg
position and have him perform the Valsalva
maneuver
49. •Remove cath and apply pressure with an
occlusive dressing over a petroleum gauze
•Check cath to ensure tip is intact
•Document how patient tolerated procedure,
placement of dressing and cath tip intact.
50. Documentation
Document all dressing, tubing, and solution
changes.
Document the patient’s tolerance of the
procedure,
the date and time of catheter removal, and the
type of dressing applied.
Note the condition of the catheter insertion site
and whether a culture specimen was collected.
Note any complications and actions taken.