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Measuring Central Venous Pressure Checklist

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DE LA SALLE LIPA

COLLEGE OF NURSING
Health Assessment NCM 118
Procedural Checklist in
Measuring Central Venous Pressure

NAME: __________________________________________________________
YEAR / SECTION: _________________ RATING: __________

General Objective:

Given actual or simulated situation/condition, the student will be able to safely and accurately
measure central venous pressure with maximum comfort and safety for the client and nurse.

Specific Objectives:
1. Understand why central venous monitoring is performed.
2. Demonstrate how to perform central venous pressure monitoring using a manometer.
3. Identify the normal and abnormal parameters of CVP
4. Analyze the data gathered from the assessment and formulate valid nursing diagnosis,
collaborative problems and/or referrals

CRITERIA:
Item Descriptors Verbal Interpretation
Weight
2 Excellent Performed the procedure with great ease and confidence, observing work
ethics (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows diligence in documenting observations at all
times.
1.5 Very Performed the procedure with less confidence, observing work ethics
Satisfactory (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows minimal diligence in documenting observations.
1.25 Satisfactory Performed the procedure but requires close supervision and shows
potential for improvement.
1 Needs Failed to perform the procedure, unable to function well and needs
Improvement repeated specific/ detailed guidance or direction.

No. STEP BY STEP PROCEDURE 1 0.75 0.5 0.25 REMARKS


A. EYES
BASIC NURSING SKILLS
∙ Prepare all the equipment needed with primed IV
1 tubing and syringe prefilled with 10cc PNSS
∙ Introduce self
∙ Check patient’s identity.
∙ Explain the procedures
2
∙ Secure informed consent
∙ Maintain privacy
∙ Wear adequate PPE

Perform hand hygiene, wear gloves, clean the


3 catheter port with alcohol pad for 15 seconds and
flush your catheter to ensure patency.
Connect to the three-way stopcock that
4 communicates to IV fluid and central venous
catheter.
5 Attach the extension tubing with ruler or your
manometer to the three-way stopcock.
6 Place the patient in a supine position and confirm
zero point or the phlebostatic level.

7 Position the zero point of the manometer at the level


of the right atrium.
8 Turn the stopcock knob so that the IV solution flows
into the manometer filling to about 20-25cm level.
Then turn the stopcock so that the solution in
9 manometer flows into the patient and closed
from the IV fluid.
10 Observe the fall in the height of the column of
fluid in the manometer.
11 Record the level at which the solution stabilizes
or stops moving downward.
Turn the stopcock again to allow IV solution to flow
from solution bottle into the patient’s veins and
12 regulate per doctor’s order.
13 Detach the extension tubing of the manometer to
the three-way stopcock and recap aseptically.
Reposition the client to a comfortable position.
14 Convert obtained measurement to mmHg and
record.
End the procedure
15 ∙ Keep patient informed
∙ Clean all the equipment
∙ Wash hands.
∙ Document findings
∙ Refer

COMMENTS:

Strengths:

Weaknesses: Evaluated by:

________________________________ KENNETH O. LUBIGAN, RN, MAN


Student’s Signature over Printed Name CI’s Signature over Printed Name

Date: ______________ Date: / /2022

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