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    Sub - Medical Surgical Nursing: Assignment On CVP Monitoring

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    kamini Choudhary
    Central venous pressure (CVP) measurement is important for monitoring critically ill patients. CVP is measured using a central venous catheter connected to a pressure manometer or transducer. Normal CVP ranges from 5-10 cm H2O. CVP can be measured from the internal jugular, subclavian, or femoral veins. To measure CVP using a manometer, the manometer is leveled with the phlebostatic axis and zeroed before opening the IV line and allowing the fluid to stabilize at the level equaling right atrial pressure. Abnormal CVP readings should be interpreted along with other vital signs. Potential complications of CVP measurement include hemorrhage, infection, occlusion, and air

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    Sub - Medical Surgical Nursing: Assignment On CVP Monitoring

    Uploaded by

    kamini Choudhary
    629 views11 pages
    Central venous pressure (CVP) measurement is important for monitoring critically ill patients. CVP is measured using a central venous catheter connected to a pressure manometer or transducer. Normal CVP ranges from 5-10 cm H2O. CVP can be measured from the internal jugular, subclavian, or femoral veins. To measure CVP using a manometer, the manometer is leveled with the phlebostatic axis and zeroed before opening the IV line and allowing the fluid to stabilize at the level equaling right atrial pressure. Abnormal CVP readings should be interpreted along with other vital signs. Potential complications of CVP measurement include hemorrhage, infection, occlusion, and air

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    CVP Monitoring

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    Central venous pressure (CVP) measurement is important for monitoring critically ill patients. CVP is measured using a central venous catheter connected to a pressure manometer or transducer. Normal CVP ranges from 5-10 cm H2O. CVP can be measured from the internal jugular, subclavian, or femoral veins. To measure CVP using a manometer, the manometer is leveled with the phlebostatic axis and zeroed before opening the IV line and allowing the fluid to stabilize at the level equaling right atrial pressure. Abnormal CVP readings should be interpreted along with other vital signs. Potential complications of CVP measurement include hemorrhage, infection, occlusion, and air

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    629 views11 pages

    Sub - Medical Surgical Nursing: Assignment On CVP Monitoring

    Uploaded by

    kamini Choudhary
    Central venous pressure (CVP) measurement is important for monitoring critically ill patients. CVP is measured using a central venous catheter connected to a pressure manometer or transducer. Normal CVP ranges from 5-10 cm H2O. CVP can be measured from the internal jugular, subclavian, or femoral veins. To measure CVP using a manometer, the manometer is leveled with the phlebostatic axis and zeroed before opening the IV line and allowing the fluid to stabilize at the level equaling right atrial pressure. Abnormal CVP readings should be interpreted along with other vital signs. Potential complications of CVP measurement include hemorrhage, infection, occlusion, and air

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    The key takeaways are that CVP is measured using a manometer or transducer inserted via a CVC, the normal range is 5-10 cmH2O, and factors like medications and treatments can affect readings. CVP should be interpreted along with other vital signs.

    The main reasons for measuring CVP are to monitor circulating blood flow into the right atrium, assess fluid status, and determine how often measurements should be taken based on a patient's condition and treatments being administered.

    Common sites for CVC insertion include the internal jugular vein, subclavian vein, and femoral vein, each with their own risks and benefits.

    Sub - Medical Surgical Nursing

    Assignment on CVP Monitoring

    Submitted To: Submitted By:

    Ms Anjali kamini

    Nursing Lecturer msc (N) 1st yr

    PIPRAMS PIPRAMS

    Submitted on : 27/April/2021
    Introduction -

    Central venous pressure measurement is often associated with intensive and critical care settings. However,
    with increasing numbers of critically ill patients being cared for on medical and surgical wards, it is essential
    that clinicians are able to record central venous pressure measurement accurately and recognisenormal and
    abnormal parameters.

    Reasons for measuring CVP -

    Circulating blood flows into the right atrium via the inferior and superior vena cava. The pressure in the right
    atrium is known as central venous pressure (CVP). The condition of the patient and the treatment being
    administered determine how often CVP measurement should take place, for example, critically ill unstable
    patients may need hourly measurements.

    Measuring central venous pressure -


    CVP is measured using an indwelling central venous catheter (CVC)
    and a pressure manometer or transducer. Both methods are

    reliable when used correctly.


    Wards generally use manometers.

    Equipment: transducers

    Accident and Emergency departments, High Dependency areas and Intensive Care units use transducers for
    measuring CVPs.
    TransducedCVP waveform

    Insertion sites
    CVC insertion sites include:

    •Internal jugular vein

    •Subclavianvein
    •Femoral vein

    Measuring central venous pressure-

    Internal jugular veins-


    This site is chosen frequently as there is a high rate of successful insertion and a low incidence of
    complications such as pneumothorax. Internal jugular veins are short, straight and relatively large allowing
    easy access, however, catheter occlusion may occur as aresult of head movement and may cause irritation in
    conscious patients.
    Subclavianveins-
    This site is often chosen as there are more recognisableanatomical landmarks, making insertion of the device
    easier. Because this site is positioned beneath the clavicle there is a risk of pneumothoraxduring insertion. A
    subclavianCVC is generally recommended as it is more comfortable for the patient.
    Femoral veins
    This site provides rapid central access during an emergency suchas a cardiac arrest. As the CVC is placed in a
    vein near the groin there is an increased risk ofassociated infection. In addition, femoral CVCsare reported to
    be uncomfortable and may discourage the conscious patient from moving.

    CVP recording -

    CVP is usually recorded at the mid-axillaryline where the manometer arm or transducer is level with the
    phlebostaticaxis. This is where the fourth intercostalspace and mid-axillaryline cross each other allowing the
    measurement to be as close to the right atrium as possible.

    Using a menometer-

     . Explain the procedure to the patient to gain informed consent.


     If IV fluid is not running, ensure that the CVC is patent by flushing the catheter.3.
    Place the patient flat in a supine position if possible. Alternatively, measurements
    can be taken with the patient in a semi-recumbent position. The position should
    remain the same for each measurement taken to ensure an accurate comparable
    result.

    Measuring central venous pressure -


    4

     Line up the manometer arm with the phlebostaticaxis


    ensuring that the bubble is between the two lines of the
    spirit leve

     Move the manometer scale up and down to allow the


    bubble to be aligned with zero on the scale. This is
    referred to as 'zeroing the manometer'.Open the IV
    fluid bag and slowly fill the manometer to a level
    higher than the expected Using a manometer

     Turn the three-way tap off to the patient and open to the manometer

     Open the IV fluid bag and slowly fill the manometer to a level higher than the expected CVP

     Turn off the flow from the fluid bag and open the three-way tap from the manometer to the patient

     The fluid level inside the manometer should fall until gravity equals the pressure in the central veins.

     .

     When the fluid stops falling the CVP measurement can be read. If the fluid moves with the patient's
    breathing, read the measurement from the lower number

     Turn the tap off to the manometer


    Measuring central venous pressure -

    Interpreting measurements

    The normal range for CVP is 5-10cm H2O (2-6mmHg) when taken from the mid-axillaryline at the fourth
    intercostalspace.
    Many factors can affect CVP, including vessel tone, medications,heart disease and medical treatments. A CVP
    measurement should be viewed in conjunction with other observations such as pulse, blood pressure and
    respiratory rate and the patients response to treatment.

    Potential complications -

    Haemorrhage -from the catheter site -if it becomes disconnected from the infusion. Patients who have
    coagulation problems such as those on warfarinor those will clotting disorders are at risk

    .Catheter -occlusion, by a blood clot or kinked tube -regular flushing of the CVC line and a well secured
    dressing should help to avoid this.

    Infection-redness, pain, swelling around the catheter insertion site may all indicate infection. Careful asepsis is
    needed when touching a CVC site. Swabs for MC&S should be taken if infection is suspected.

    Air embolus-if the infusion or monitoring lines become disconnected there is a risk that air can enter the
    venous system. All lines and connections should be checked at the start of every shift to minimisethe risk of this
    occurring.

    Catheter displacement-if the CVC moves into the chambers of the heart then cardiac arrhythmias may be
    noted, and should be reported. If the CVC is no longer in the correct position, CVP readings and medication
    administration will be affected.
    References-

     Cole E (2007) Measuring central venous pressure.Nursing Standard. 22 (7) 40-42Hamilton H(2006a)
    Complications associated with venous access devices: part one. Nursing Standard.20, 26, 43-50.

     Hamilton H(2006b) Complications associated with venous access devices: part two. Nursing
    Standard.20, 27, 59-65.

     Jevon P, Ewens B (Eds)(2007) Monitoring the Critically Ill Patient.Second edition. Blackwell Science,
    Oxford.

     Morton PG, Fontaine DK, Hudak CM, Gallo BM(2005) Critical Care

     Nursing: a Holistic Approach.Eighth edition. Lippincott Williams and Wilkins, Philadelphia PA.
    National Institute for Clinical Excellence(2002) Central Venous Catheters: Ultrasound Locating
    Devices.Technology appraisal No. 49. NICE, London.

     Wiklund CU, Romand JA, Suter PM, Bendjelid K(2005) Misplacement of central vein catheters in
    patients with hemothorax: a new approach to resolve the problem. Journal of Trauma.59, 4, 1029-1031.

     Woodrow P(2002) Central venous catheters and central venous pressure. Nursing Standard.16, 26, 45-
    51.

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