8/13/2019 CVP Report

1/37

Central

VenousPressure

(CVP)

8/13/2019 CVP Report

2/37

(CVP) Central Venous

PressureO Is a measure of the pressure within the

right atrium of the heart.

O It measures the ability of the right side ofthe heart to deal with the systemic fluid

load.

O Its changes reflect the clients overall fluid

volume status.

8/13/2019 CVP Report

3/37

IndicationsO CVP measurement

O Drug and fluid administration

O Nutrition and feedingO Cardiac pacing

8/13/2019 CVP Report

4/37

Other IndicationsO Fluid resuscitation in major trauma

O Cardiac surgery

O Thoracic surgeryO Major abdominal surgery

O To optimize fluid replacement in acute

renal failure

O To optimize fluid replacement duringsepsis

O To guide fluid replacement in heart failure

8/13/2019 CVP Report

5/37

Normal CVP= 2-6 mmHg

8/13/2019 CVP Report

6/37

8/13/2019 CVP Report

7/37

CVP is affected by:O Intrathoracic

pressure or

musculoskeletal

pumpO Vascular tone

O Obstruction

8/13/2019 CVP Report

8/37

2 Common type of CVP

8/13/2019 CVP Report

9/37

8/13/2019 CVP Report

10/37

8/13/2019 CVP Report

11/37

8/13/2019 CVP Report

12/37

O To ensure the

accuracy of the

CVP Reading,

the manometer

must always be

positioned in thesame place,

relative to the

right atrium.

8/13/2019 CVP Report

13/37

Nursing Process

8/13/2019 CVP Report

14/37

8/13/2019 CVP Report

15/37

DiagnosisO Risk for infection

O Risk for deficient fluid volume

O Impaired skin integrity

8/13/2019 CVP Report

16/37

PlanningO Expected Outcomes:

1. The clients CVP will be measured

accurately.2. The aseptic technique will be

maintained.

3. The client will not suffer any

complications as a result of the CVPmeasurement.

8/13/2019 CVP Report

17/37

8/13/2019 CVP Report

18/37

8/13/2019 CVP Report

19/37

O Estimated time to complete the skill is 5-

10 minutes

8/13/2019 CVP Report

20/37

Implementation

8/13/2019 CVP Report

21/37

8/13/2019 CVP Report

22/37

Insertion phase :

( by physician )1. The CVP site is surgically cleaned

2. Assist the patient to remaining motionlessduring insertion .

3. Monitor for dysrhythmias , tachypnea,tachycardia as catheter threaded to greatveins is connect primed IV tubing tocatheter and allow IV solution to flow .

4. The catheter should be suture in place .

5. Place a sterile occlusive dressing over site.

6. Obtain a chest x-ray.

8/13/2019 CVP Report

23/37

8/13/2019 CVP Report

24/37

8/13/2019 CVP Report

25/37

Move the manometer scale up and down to

allow the bubble to be aligned with zero onthe scale. This is referred to as 'zeroing the

manometer'.

8/13/2019 CVP Report

26/37

O Turn the three-

way tap off to the

patient and open

to themanometer.

8/13/2019 CVP Report

27/37

8/13/2019 CVP Report

28/37

O Turn off theflow from the

fluid bag and

open the three-

way tap from

the manometer

to the patient

8/13/2019 CVP Report

29/37

O The fluid level

inside themanometershould fall

until gravityequals thepressure inthe centralveins

8/13/2019 CVP Report

30/37

O When the fluid stops falling the CVP

measurement can be read. If the fluidmoves with the patient's breathing, read

the measurement from the lower number.

8/13/2019 CVP Report

31/37

O Turn the tap off to

the manometer

8/13/2019 CVP Report

32/37

Low CVP reading is caused by

O Hemorrhage

O Excessive dieresis- result of diabetes ordiuretic therapy

O Poor venous return- eg. Cardiogenic

shock

O Peripheral vasodilation- result ofsepticemia or vasodilatory therapy

8/13/2019 CVP Report

33/37

8/13/2019 CVP Report

34/37

Special ConsiderationsO Arrange for daily chest X-rays to check

catheter placement, as ordered.

O Care for the insertion site according to facility

policy.O Change the dressing every 24 to 48 hours.

O Be sure to wash your hands before dressingchanges; use aseptic technique and sterilegloves when redressing the site.

O When removing the old dressing, observe forsigns of infection, such as redness, and notepatient complaints of tenderness.

8/13/2019 CVP Report

35/37

O Apply ointment if directed by facility policy,then cover the site with a sterile gauzedressing or a clear occlusive dressing.

O

After the initial CVP reading, reevaluatereadings frequently to establish a baseline forthe patient.

O Authorities recommend obtaining readings at15-, 30-, and 60- minute intervals to establisha baseline.

O If the patients CVP fluctuates by more than 2cm H2O, suspect a change in his clinicalstatus and report this finding to the physician.

8/13/2019 CVP Report

36/37

8/13/2019 CVP Report

37/37

Potential ComplicationsO Haemorrhage

O Catheter

O InfectionO Air Embolus

O Catheter Displacement