Introduction

Description: Central venous pressure (CVP) refers to the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP provides insights into the amount of blood returning to the heart and the heart’s ability to pump blood into the arterial system.

Objectives:

1. Serve as a guide for fluid replacement in seriously ill patients.
2. Estimate blood volume deficits.
3. Determine pressures in the right atrium and central veins.
4. Evaluate for circulatory failure within the total clinical picture of a patient.

Indications: Patients with cardiovascular disorders.

Nursing Alert: CVP readings should not be relied upon alone; they must be used in conjunction with other assessment data. Any abnormal findings should be promptly reported to the doctor.

Equipment:

1. Venous pressure tray
2. Cut-down tray
3. Infusion solution and infusion set
4. 3-way or 4-way stopcock (pressure transducer may also be used)
5. IV pole attached to bed
6. Arms board
7. Adhesive tape
8. ECG monitor
9. Carpenter’s level (for establishing zero point)

Nursing Interventions:

1. Assemble equipment according to manufacturer’s directions.
2. Explain that the procedure is similar to an IV, and the patient may move in bed as desired after the passage of the CVP catheter.
3. Place the patient in a comfortable position as a baseline for subsequent readings. Serial CVP readings should be consistent in terms of patient position to avoid inaccuracies.
4. Attach the manometer to the IV pole, ensuring the zero point aligns with the patient’s right atrium, located at the midaxillary line, about 1/3 of the distance from the anterior to the posterior chest wall.
5. Mark the midaxillary line on the patient as an external reference point for the manometer’s zero level.
6. Connect the CVP catheter to a 3-way stopcock or transducer for monitoring.
7. Start the IV flow, filling the manometer 10 cm above the anticipated reading.
8. Surgically cleanse the CVP site, and insert the catheter through an antecubital, subclavian, or internal/external jugular vein into the superior vena cava, confirming placement via fluoroscopy or chest x-ray.
9. Observe for respiratory fluctuations as the catheter enters the thorax, and monitor the patient’s ECG during insertion.
10. Suture and tape the catheter in place, apply a sterile dressing, and label it with the time and date of insertion.
11. Adjust the infusion rate to prevent a rapid increase in venous pressure.

Measuring Central Venous Pressure:

1. Place the patient in the identified position and confirm the zero point at the level of the right atrium.
2. Position the zero point of the manometer at the level of the right atrium, ensuring consistency in measurements.
3. Turn the stopcock to fill the manometer, observe the fall in fluid height, and record the stabilized level as the central venous pressure (CVP). CVP may range from 5-12 cm H2O.
4. Assess the patient’s clinical condition, interpreting CVP readings within the context of the entire clinical picture. Frequent changes in measurements will guide the detection of fluid load handling by the heart and the presence of hypovolemia or hypervolemia.
5. A CVP of zero indicates hypovolemia, and a CVP above 15-20 cm H2O may suggest either hypervolemia or poor cardiac contractility.
6. Turn the stopcock to allow IV solution flow into the patient’s veins when not recording readings.

Charting:

1. Location of insertion site
2. Type and size of needle or cannula used for insertion
3. Time of insertion
4. Appearance of needle insertion site.