CVP micro teaching.pptx

CVP procedure for b.sc nursing and m.sc nursing students..

1. VIVEKANANDA COLLEGE OF NURSING MICRO-TEACHING PRACTICE PRESENTED BY- APURVA DWIVEDI [M.Sc. NSG. 1 ST YR.]

2. Central venous pressure

3. Overview Introduction Measurement of CVP Factors affecting CVP Low central venous pressure Elevated central venous pressure Why do we measure CVP? Methods to measure CVP CVP-transducer set-up Set up of equipment Position of CVP patient Access of CVP Nurses role

4. Introduction Central venous pressure, which is a measure of pressure in the vena cava, can be used as an estimation of preload and right atrial pressure. Central venous pressure is often used as an assessment of hemodynamic status, particularly in the intensive care unit. The central venous pressure can be measured using a central venous catheter advanced via the internal jugular vein and placed in the superior vena cava near the right atrium. A normal central venous pressure reading is between 8 to 12 mmHg. This value is altered by volume status and/or venous compliance.

5. Measurement Normal CVP in patients can be measured from two points of reference: Sternum : 0–14  cm H 2 O Midaxillary line : 8–15 cm H 2 O 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. In most  intensive care units , facilities are available to measure CVP continuously. Normal values vary between 4 and 12 cmH 2 O.

6. Site Normal pressure range (in  mmHg ) [5] Central venous pressure 3–8 Right ventricular pressure systolic 15–30 diastolic 3–8 Pulmonary artery pressure systolic 15–30 diastolic 4–12 Pulmonary vein/ Pulmonary capillary wedge pressure 2–15 Left ventricular pressure systolic 100–140 diastolic 3–12

7. Factors affecting 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

8. Conti.. Factors that decrease CVP include: Deep  inhalation Distributive shock Hypovolemia

9. Low central venous pressure Some factors that can decrease central venous pressure are hypovolemia or vasodilation. Either of these would decrease venous return and thus decrease the central venous pressure. A decrease in central venous pressure is noted when there is more than 10% of blood loss or shift of blood volume. A decrease in intrathoracic pressure caused by forced inspiration causes the vena cave to collapse which decreases the venous return and, in turn, decreases the central venous pressure.

10. Elevated central venous pressure Elevated Central Venous Pressure can occur in heart failure due to decreased contractility, valve abnormalities, and dysrhythmias. Any patients on ventilator assistance that have excessive positive end-expiratory pressure would have an increase in pulmonary arterial resistance which causes an increase in central venous pressure. However, an increased central venous pressure caused by increased pulmonary arterial resistance can also be affected by a decrease in the fraction of inspired oxygen, an increase in ventilation/perfusion abnormalities in the lung, an increase in pericardial pressure, or an increase in intra-abdominal pressure which would increase thoracic pressure. Increased juxta-cardiac pressure - tension pneumothorax, pericardial tamponade, right ventricular infarct, right ventricular outflow obstruction - can also decrease venous return.

11. Why do we measure CVP? To serve as a guide of fluid balance in critically ill patients 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.

12. Methods to measure CVP

13. CVP-transducer set-up ✓500ml NS ✓ Pressure bag ✓ Transducer KIT ✓ Transducer holder ✓ Transducer pressure cable

14. Set up of equipment Maintain aseptic technique Open the transducer set and tighten all the connections Hang the 500 ml saline in the pressure bag, and spike it. Inflate the pressure bag to 300 mm hg and turn stopcock to upwards position. Clamp iv tubing Place the transducer holder on IV pole Place transducer in transducer holder attach the IV tubing and the PM line in the transducer kit Unclamp the tubing and remove air from the tubing by activating the flush device. Point stopcock of the transducer horizontal and do the tubing's

15. Position of CVP patient

16. Access of CVP

17. Nurses role Monitor for the signs of complications. Assess for patency of the CVP line. Sterile dressing should be done to prevent infection( CVP care per the hospital protocol) The length of the indwelling catheter should be recorded and regularly monitored.

18. Summary We have learned about Introduction, Measurement of CVP, Factors affecting CVP, Low central venous pressure, Elevated central venous pressure, Why do we measure CVP?, Methods to measure CVP, CVP-transducer set-up, Set up of equipment, Position of CVP patient, Access of CVP and Nurses role.

19. Conclusion Central venous pressure estimates the right atrial pressure pulmonary capillary wedge pressure estimates the left atrial pressure. The values reflect end-diastolic volume, or pre load, of the right and left ventricles, respectively. Central venous pressure and pulmonary capillary wedge pressure both would have been decreased because of the loss of blood volume from the venous side.

20. Bibliography Book reference ‘‘SUDDARTH’S AND BRUNNER’’, Text book of medical surgical nursing,volume-1,edition-13,wolters Kluwer publisher, Page no ‘‘CHINTAMANI, MRINALINI, HARINDARJEET GOYAL;’’ Lewis’s medical surgical nursing ,volume2,1 st edition-2011, Elsevier publisher, page no. Net reference https://www.ncbi.nlm.nih.gov/books/NBK519493/#:~:text=Central%20venous%20pressure%2C%20which%20is,in%20the%20intensive%20care%20unit.