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Skills Lab

Central Venous Pressure Monitoring


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Measurement of RA pressure or the pressure of the great veins within the thorax
Right-sided cardiac function is assessed through evaluation of the CVP
Catheter tip is position in the RA, upper portion of the superior vena cava or inferior vena cava

Normal values 2 8 mm Hg
Low CVP = hypovolemia or venous return
High CVP = over hydration, venous return, or right-sided heart failure
Phlebostatic Axis 4th ICS, mid-axillary line
Procedure
1. Review the facility/unit specific protocol for
setting up a water manometer
2. Review treating clinicians order for a water
manometer
3. Review patients medical history for any
allergies; then use alternative materials if
needed
4. Gather supplies and equipment

Establish privacy by closing the door to


patients room and/or drawing the curtain
surrounding patients bed
6. Identify patient. Introduce self to patient and
assess the patient.
7. Explain the procedure, purpose, outcome to
expect and answer any questions.
8. Place patient in comfortable position. Lower
side rails for easier access.
9. Open the water manometer and check for
defects.
10. Attach the manometer to the IV pole or
bedside stand

Rationale
REVIEW CHART HERE

Non-sterile gloves
IV pole
Manometer tubing with 3 way stopcock
Extension tubing
Pen marker
IV solution (D5W or PNSS)
Tape

5.

11. Using a leveling device, alight zero mark of


the manometer tubing with the patients
phlebostatic axis
12. Mark the phlebostatic axis using waterproof
ink.
13. Attach the 3 way stopcock to bottom of
manometer and tighten the tubing. Turn
stopcock so that its closed on all ports.
14. Connect the tubing to the patient port of the
stopcock and tighten the connection
15. Spike IV solution and prim the drip chamber
of the IV tubing

P.Chan 2017

To ease anxiety and establish rapport.


Provide emotional support
Either supine or semi-fowlers. All subsequent
readings must be in this position

The zero point of the manometer should be on a level


with the patients right atrium. The right atrium is at
the midaxillary line, which is about 1/3 of the distance
from the anterior to the posterior chest wall.

To make sure all future measurements utilize the same


reference point

Squeeze until it is half-filled with IV solution (Closed


roller clamp)

Skills Lab

16. Open roller clamp and prime the rest of the IV


tubing.
17. Tightly attach the IV tubing to the 3 way
stopcock so that its open to flush port and
manometer tubing.
18. Open the roller clamp and allow the flush
solution to slowly fill the manometer tube to
20 25 cm H20
19. Turn 3 way stopcock so that its closed to the
manometer then open the flush solution and
the patient
20. Prime the extension tubing with IV solution
and close all ports
21. Connect the distal end of the catheter to the
proximal end of pressure tubing
22. Close the stopcock to the manometer tubing
and open to the patient and flush tubing to
verify patency
23. Close stopcock to IV solution and open
patient to manometer tubing
24. Replace all vented end caps with sterile
nonvented end caps
25. Label the IV tubing and flush solution with
the date and time they were first used with
nurses initials.
26. Documentation and assessment findings.

Higher than patients expected. Do not overfill to avoid


contamination.

Fluid level should fluctuate with respirations.

CVP may range from 5 12.


A CVP zero indicates that patient is hypovolemia
(verified if rapid infusion causes patient to improve)
A CVP above 15-20cm. HOH may be due to either
hypervolemic or poor cardiac contractility.
Charting:
Location of insertion site
Type and size of needle or cannula used for insertion
Time of insertion
Appearance of needle insertion site

P.Chan 2017

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