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Prepeared By Dr: Manal Moussa

Prepeared By Dr: Manal Moussa. LEARNING OUTCOMES. By the end of this session the student should be able to : Explain the indications for a patient requiring CVP monitoring Identify the equipment required for commencing CVP monitoring

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Prepeared By Dr: Manal Moussa

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  1. Prepeared By Dr: Manal Moussa

  2. LEARNING OUTCOMES • By the end of this session the studentshould be able to : • Explain the indications for a patient requiring CVP monitoring • Identify the equipment required for commencing CVP monitoring • Describe the nursing role, both in the care and use of the central venous monitoring line • Discuss the reasons for abnormal CVP readings.

  3. DEFINITION Blood from the systemic veins flows into the right atrium. The pressure in the right atrium is the CVP. A catheter is passed via; the subclavian vein or jugular vein into the superior vena cava to determine the venous return and intravascular volume of the right atrium. The normal value is 6-12cm H2O

  4. PURPOSE • To serve as a guide of fluid balance in critically ill patients (To guide the administration of fluid or diuretics.) • To estimate the circulating blood volume • To determine the function of the right side of the heart • To assist in monitoring circulatory failure • None of these variables are measured directly; they must be interpreted.

  5. Cephalic vein Axillary vein Median cubital vein Basilic vein ACCESS Subclavian vein External Jugular vein

  6. COMPLICATIONS • Carotid Artery Puncture • Pneumothorax • Air Embolism • Arrhythmia • Perforation of SVC or R. Atrium/Ventricle • Infection • Pleural Effusion • Extravasion • Allergic reaction to catheter material

  7. EQUIPMENT a. d. b. e. c. The equipment needed for measurement of central venous pressure includes a sterile bag of fluids (a) with attached fluid administration set (b), an IV extension set (c), a manometer (d) and a stopcock (e).

  8. EQUIPMENT IV extension set to entry port of patients central line. IV giving setto fluid bag. Stopcock (Three way tap)

  9. a. b. c. DIRECTION OF FLOW -The white arrows indicate the direction of fluid flow. -Initially the white knob is turned straight up towards the manometer, allowing fluid to flow from the fluid bag to the patient's catheter to assure the catheter is patent (a). -If fluid does not flow freely into the patient's catheter a valid CVP reading will not be obtained.

  10. -Then the knob is turned toward the patient (b) and fluid will fill the manometer. -The manometer should not contain any air bubbles. -If air is present in the manometer or fluid line, let the fluids run, overfilling the manometer until all air is purged from the system.

  11. -Then turn the knob toward the fluids (c). -The level of fluid in the manometer will fall (the fluid is running into the patient's catheter) until the height of the fluid column exerts a pressure equivalent to the patient's central venous pressure. -The top of the fluid column will slightly oscillate up and down.

  12. -Take the CVP reading when the fluid level stabilizes at the end of expiration. -Turn the stopcock off to the manometer and run the IV fluids through the central venous line as prescribed. Post care: Patient: Return the patient to correct position. Nurse: Handwash. Environment: Return equipment. Documentation: Document the reading.

  13. POSITION OF PATIENT FluidBag manometer 3-way tap CentralVenousAccess Patient in supine position phlebostatic axis

  14. INTERPRETATION • An increase of above normal may indicate weakening or failure of the right side of the heart, or excessive intravascular volume • A pressure below 5cm H2O usually reflects an intravascular volume deficit or drug induced excessive vasodilation • CVP measurements must not be interpreted on their own, but viewed alongside the patient's full clinical picture • (BP, Respiratory Pattern, Colour, Temperature) • Several measurements are required to identify a trend

  15. DETERMINANTS Cardiac Competence (reduced ventricular function raises CVP) Blood Volume (increased venous return raises CVP) CVP Intra Aortic &Intra Peritoneal Pressure (raises CVP) Systemic Vascular Resistance (raises CVP)

  16. REFERENCES Henderson N., (1997) Central Venous Lines Nursing Standard 11:42, pp49-56 Mallett J., (2000) The Royal Marsden NHS Trust Dougherty L., Manual of Clinical Nursing Procedures, Fifth Edition Oxford; Blackwell Science, pp630-635. Mc Dermott M., (1995) Central Venous Pressure Nursing Standard 9:35, pp54 Nursing Standard., (1999) Quick Reference Guide 6. Central Venous Lines Nursing Standard 13:42.

  17. THANK YOU

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