Definition
Central venous pressure (CVP) is a measure of the pressure within the right atrium of the heart. CVP can be measured using a manometer attached to the intravenous fluid line, in terms of fluid pressure in the column of the manometer.
Articles
A tray containing:
- IV tubing.
- Manometer set.
- Stopcock if not included in the manometer set.
- Indelible ink marking pen.
- Normal saline.
- Adhesive tape.
- Face mask.
- Sterile gloves.
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Inform patient what will be done. | Knowledge of what to expect will reduce anxiety. |
| 2 | During procedure Wash hands and apply gloves. | Reduces transmission of microorganism |
| 3 | Gather needed articles at the bedside. | Maximizes efficiency and minimizes chance of breaking sterility once started. |
| 4 | Position client in supine or flat position with no pillows under head (if this position is not tolerated have the client in semi-Fowler’s position). Mark the level of right atrium (at the mid-axillary line about one-third of the distance from anterior to posterior chest wall) in 4th intercostal space with an “x” mark using indelible ink pen. | The term phlebostatic axis may be used to identify the level of the atrium. |
| 5 | Fix the manometer on an IV pole such that it is zeroed at the “X”mark. | Helps minimize variance in measurement |
| 6 | Connect the IV fluid (usually normal saline) to a three-way stopcock and flush the other two ports. | Forces air out of the stopcock. Fluids with glucose are stickier than normal saline and may cause manometer to stick, thus glucose solution to be avoided. |
| 7 | Apply sterile gloves and mask. | Aseptic technique minimizes chance of infection. |
| 8 | Connect the CVP manometer to the upper port of the stopcock. | |
| 9 | Connect the CVP tubing from the client to the second side port of stopcock. | Establishes IV line from normal saline to CVP catheter. |
| 10 | Turn stopcock off to client and fill manometer with normal saline to the 20 cm mark above the anticipated reading. | The normal CVP reading varies from 8 to 12 cm of water. |
| 11 | Hold manometer at the phlebostatic axis and turn the stopcock off to the normal saline. | System is open from the manometer to the client. |
| 12 | Watch as the fluid falls in the manometer; take the central venous pressure reading when the fluid stabilizes. | The fluid will stabilize at a level equal to the pressure in the right atrium or central veins. If the fluid level fluctuates with the client’s respiration, take the reading at the end of the client’s expiration. |
| 13 | Turn the stopcock off to the manometer. | Reestablishes fluid flow from the IV to the client.ms |
| 14 | Reposition the patient. | |
| 15 | Keep the manometer in an upright position (Usually hanging from the iv pole) to prevent bubbles from entering the fluid column or the client and to prevent contamination of the manometer | The top of the manometer remains open to the air. If manometer is not properly stored, contaminants or air can enter the manometer and be flushed into the client. |
| 16 | After procedure Wash and dry hands. | Prevents spread of microorganisms. |
| 17 | Document the reading obtained in the client’s medical record (Flow sheet and/or Nurses record). | Provides continuity of care. |
Geriatric variation
Geriatric patients may not be able to lie flat or supine. Any position, less than optimal used for measuring CVP must be entered in the nurse’s notes, Kardex and conveyed verbally at change of shifts.
Paediatric variation
It is important that the right atrium is clearly marked and that all readings are zeroed to ensure that all variations in the CVP measurements are hemodynamic changes, and not technique variations.
Notes:
- For patients on mechanical ventilation with use of positive end-expiratory pressure (PEEP), subtract the amount of PEEP applied from the obtained reading of CVP.
- During CVP measurement, other fluids administered through CVP line, if any, should be disconnected. Once the CVP reading is obtained, other fluids can be restarted.
- In case of continuous CVP monitoring-Make sure the stopcock is turned so that the IV solution port, CVP column port, and patient port are open. Be aware that with this stopcock position, infusion of the IV solution increases CVP.
- Therefore, expect higher readings than those taken with the stopcock turned off to the IV solution. If the IV solution infuses at a constant rate, CVP will change as the patient’s condition changes, although the initial reading will be higher. Assess the patient closely for changes. Record CVP values at appropriate intervals.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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