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Central venous pressure

Central venous pressure


• Central venous pressure (CVP) is the blood
pressure in the venae cavae, near the right atrium
of the heart.
• CVP reflects the amount of blood returning to the
heart and the ability of the heart to pump the
blood back into the arterial system.
• CVP is often a good approximation of right atrial
pressure (RAP)
• CVP monitoring is a useful tool to guide
hemodynamic therapy
Measurement:
• Normal CVP in patients can be measured from
two points of reference:
• Sternum: 0–14 cm H2O
• Midaxillary line: 8–15 cm H2O
• CVP can be measured by connecting the patient's
central venous catheter to a special infusion set
which is connected to a small diameter water
column.
• If the water column is calibrated properly the
height of the column indicates the CVP.
Factors that increase CVP include:

• Cardiac tamponade
• Decreased cardiac output
• forced exhalation
• Heart failure
• Hypervolemia
• Mechanical ventilation and the application of positive
end-expiratory pressure (PEEP)
• Pleural effusion
• Pulmonary Embolism
• Pulmonary Hypertension
• Tension pneumothorax
Factors that decrease CVP include:

• Deep inhalation
• Distributive shock
• Hypovolemia
How to measure the CVP ?
• The CVP can be measured either manually
using a manometer or electronically using a
transducer.
• The CVP must be ‘zeroed’ at the level of the
right atrium.
• Taken to be the level of the 4th intercostal
space in the mid-axillary line while the patient
is lying supine.
How to measure the CVP ?
1. Using the manometer.
• 3-way tap is used to connect
the manometer to an
intravenous drip set on one
side, and, via extension tubing
filled with intravenous fluid, to
the patient on the other .
• It is important to ensure that
there are no air bubbles in the
tubing, to avoid administering
an air embolus to the patient.
• check that the CVP catheter
tubing is not kinked or blocked
Using the manometer.

• The 3-way tap is then


turned so that it is open
to the fluid bag and the
manometer but closed
to the patient, allowing
the manometer column
to fill with fluid
Using the manometer.

• Once the manometer


has filled adequately
the 3-way tap is turned
again – this time so it is
open to the patient and
the manometer, but
closed to the fluid bag.
Using the manometer.

• The fluid level within the


manometer column will fall
to the level of the CVP, the
value of which can be read
on the manometer scale
which is marked in
centimetres, therefore
giving a value for the CVP in
centimetres of water
(cmH2O).
• The fluid level will continue
to rise and fall slightly with
respiration and the average
reading should be recorded.

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