N - 112 MS 1 RLE
CENTRAL VENOUS PRESSURE MEASUREMENT
Meaning and Purposes
• It is the pressure within the right atrium
Purposes
1. Determine the pressure in the right atrium
2. Assess the preload of the right side of the heart
3. Guide to fluid replacement
4. Estimate the circulating blood volume
Indications of CVP
For patients with:
1. Congestive heart failure
2. Decrease in myocardial contractility
3. Renal failure
4. Tension Pneumothorax
5. Pleural effusion
6. Hypovolemia or Hypervolemia
7. Decrease in myocardial contractility
8. Decreased cardiac output
Interpretation of CVP
• An increase above normal or elevated CVP results
indicate weakening or failure of the right side of the
heart or excessive fluid blood volume
• A pressure below normal reflects an intravascular
blood volume deficits or drug-induced excessive
vasodilation
• CVP measurement must not be interpreted on
their own, but viewed alongside the patient’s full
clinical picture (BP, respiratory patter, color,
temperature)
Normal Value and Catheter Placement
• Normal CVP ranges from 4 to 12 mm Hg (ref.
Brunner) or 5 – 10 cm H2O
Veins Sites for Catheter Placement
1.Cephalic or basilic
2.Subclavian
3.External or internal jugular
Materials Needed for CVP Measurement
1.Sterile bag of fluid – normal saline solution
(isotonic)
2.Administration set
3.IV extension set
4.CVP Manometer
5.Stopcock
Nursing Care of CVP
1. Hand hygiene
2. Sterile technique when changing the central line
dressing
3. Change gauze every 48 hours; transparent
dressing every 7 days
4. Wearing clean gloves before accessing the line
port
5. Performing a 15 – 30 second “hub scrub” using
friction in a twisting motion
6. Antiseptic-containing port protectors to cover
connectors
7. Assess catheter site
Skill 9: CVP Measurement
1.Informs patient of the procedure.
2.Washes hands
3.Provides for client’s privacy
4.Places the client in supine position (if
contraindicated, adjusts the position).
5.Places the manometer at zero level adjacent to
the 5th ICS midaxillary line.
6.Opens the CVP and IV port and closes patient's
Port
11.Makes sure no air has entered the IV line during
reading. Closes the CVP line and opens the IV
line to allow fluid to flow to the patient's line for
flushing.
12.Reattaches ventilator if the patient is on
ventilator. Repositions patient.
13.Regulates IV fluid as previously ordered.
14.Washes hands.
15.Documents the CVP reading, condition and
position of client when CVP reading was obtained.
7. Allows IV solution to flow to the CVP line to about
20 - 25 cm. level at the manometer
8.Closes the IV line and opens CVP line and
patient's line.
9.Instructs patient to take a deep breath and
observes for fluid fluctuation (In case intubated and
conscious, detaches patient from the ventilator
temporarily and asks patient to take a deep breath;
if intubated and unable to follow commands,
observes fluid fluctuation at the end of inspiration).
10.Notes the level where the fluctuation stabilizes.