Solutions! (Graded A+)
Clinical Use of CVP - central venous pressure approximates right atrial pressure, which is a major
determinant of right end-diastolic volume. CVP is the best indicator of right atrial preload. Normal
cardiac function requires adequate ventricular filling by venous blood.
Indications: - 1. Fluid management of hypovolemia and shock
2. Assessment of venous return and volume status
3. Operative procedures that anticipate large fluid shifts or blood loss
4. Infusion of caustic drugs and TPN
5. Aspiration of air emboli
6. Insertion of transcutaneous pacing leads
7. Venous access in patients with poor peripheral veins
8. Patients with sepsis, heart disease, respiratory failure
Contraindications: - 1. Renal cell tumor extension into right atrium
2. Fungating tricuspid valve vegetation
3. Internal jugular vein cannulation relatively CI in patients who are on anticoagulants or who have
had an ipsilateral carotid endarterectomy due to unintentional carotid artery puncture
Location for cvp monitoring - catheter tip just above or at junction of the superior vena cava and the
rt atrium.
Subclavian vein as a site for cvp monitoring - a. associated with significant risk of pneumothorax
during insertion
b. line-related infection the longer the catheter stays in place
Internal jugular as a site for cvp monitoring - a. right provides a combination of accessibility and
safety
b. left increases risk of vascular erosion, pleural effusion, and chylothorax. The thoracic duct wraps
around the internal jugular vein on left side.
Reading CVP waveform - Read at end-expiration after the a wave and before the c wave to reflect
presystolic right ventricular pressure.