Central

Venous
Pressure
Monitoring
By: Kris Lyn L. Tejerero

Central Venous Pressure (CVP)

Is the pressure in the vena

cava or right atrium

CVP represents the driving

force for filling the right
atrium and ventricle

Is used to assess right

ventricular function and
venous blood return to the
right side of the heart

Central Venous Pressure (CVP)

CVP can be continuously

measured by connecting either
a catheter positioned in the
vena cava or the proximal port
of pulmonary artery to a
pressure monitoring system

Patients in general medicalsurgical units who require CVP

monitoring may have singlelumen or multilumen catheter
placed in the superior vena
cava.

Central Venous Pressure (CVP)

Intermittent measurement of
the CVP can then be obtained
with the use of water
manometer.

CVP can also be seen as a

measurement of preload on
the right side of the heart.
Preload is the amount of
blood presented to the
heart or when the ventricle
is full before the next
ejection. Preload is the right
ventricle end-diastolic
pressure.

Normal CVP pressure is 2 to 6

mm Hg.

Other book/source: 2 - 12 mm Hg or 4

e
s
o
p
r
u
P

To serve as a guide to fluid

replacement in seriously ill
patients.
To estimate blood volume
deficits.
To determine pressures in
the right atrium and central
veins.
To evaluate for circulatory
failure (in context with total
clinical picture of patient)
For drug administration
(long term chemotherapy)
To serve as a route for hyper
alimentation.

recorded at the end of

expiration

measured by transducing
the waveform of a central
venous line

MEASUREMENT
electronic transducer

placed & zeroed at the

level of the RA (the
phlebostatic axis
usually the 4th intercostal
space in the mid-axillary
line is used)

INDICATIONS

Vascular access
Total parenteral nutrition
Infusion of irritant drugs
Measurement of central
venous pressure
Cardiac catheterization
Pulmonary artery
catheterization
Trans venous cardiac
pacing.
Hemo dialysis
Hemodynamic monitoring

CO
IN NT
D I RA
CA TI
O
N

Do not insert into an

infected area.
Avoid infraclavicular
approach to subclavian
vein if patient has apical
emphysema or bullae.
Avoid internal jugular
vein if carotid aneurysm
present on the same
side.
Bleeding diatheses
Septicaemia
Hypercoagulable states

COMMON
COMPLICATIONS

Infection
Air Embolism

A drop in CVP indicates decreased in

circulating volume w/c may result
from:
Fluid Imbalance
Hemorrhage
Severe vasodilatation
Pooling of blood in the extremities
with limited venous return

IMPORTANCE

OF CVP
MONITORING
A rise in CVP indicates an:

Increase blood volume because of a

sudden shift on fluid balance
Excessive Iv infusion
Renal Failure
Sodium or water retention

CVP catheter is inserted, it is

secured and dry, sterile
dressing is applied. Rationale:
Sterile procedure and dressing
prevents blood stream
infections.

NURSING
INTERVENTIONS

Catheter placement is
confirmed by a chest x-ray and
the site is inspected daily for
signs of infection. Rationale:
Chest x-ray can detect
malpositions of the catheter. To
prevent wound infection.

CVP catheter can be used for

infusing IV fluids, administering
IV medications and drawing blood
specimens
in
addition
to
monitoring pressure.

S
G
N
N IO To measure CVP, the transducer
I
must be placed must be placed at
S
T
R
a standard reference point called
N
U
E
the phlebostatic axis. And CVP
N RV
can be measured correctly with
E
the patient supine and backrest
T
position up to 45 degrees.
N

Rationale: Reduces risk of air

embolism during insertion And
CVP can be measured correctly
with the patient supine and
backrest position up to 45
degrees.

CVP WAVEFORM ANALYSIS

T
DominantCVP
a wave
pulmonary
Normal
Monitoring
hypertension,
H
Cannon a wave complete heart block, (VT)
A
ventricular tachycardia with AV dissociation
Dominant v wave (TR) Tricuspid
N
Regurgitation
Absent x descent (Af) Atrial Fibrilation
K

The
End

Exaggerated x descent pericardial

tamponade, constrictive pericarditis

Sharp y descent severe TR, constrictive
pericarditis
Slow y descent TR, atrial myxoma
Prominent x and y descent Right
Ventiricle (RV) infarction

Y
O
U