Central Venous Pressure (CVP)

Central Venous Pressure (CVP) I. Theoretical Concepts CVP is inserting a polyethylene catheter from the peripheral vein so that the tip is in the right atrium or at the opening of the vena cava. CVP is also called central vein catheterization (CVS). Central venous pressure directly reflects the pressure in the right atrium. Indirectly describes the right heart preload or right ventricular pressure at the end of diastole. According to Gardner and Woods, the normal value for central venous pressure is 3-8 cmH2O or 2-6 mmHg. Meanwhile, according to Sutanto (2004) the normal value of CVP is 4-10 mmHg. II. Objective 1. Blood collection for laboratory examination. 2. Measurement of central venous oxygenation. 3. Parenteral nutrition and administration of hypertonic fluids or irritating fluids that require immediate dilution in the circulatory system. 4. Administration of vasoactive drugs per drip and inotropic drugs. 5. As a venous entry point if all other IV sites are weak III. Ways of working 1.Installed Area : a. Femoral vein b. Cephalic vein c. Basal vein d. Subclavian vein e. External jugular vein f. Internal jugular vein 2.Installation Method a. Sufferers sleep on their backs (trendelenberg) b. The left shoulder is given a pillow c. Wear gloves d. Disinfection of CVP area e. Install the hole doek f. Determine the puncture site g. Give local anesthesia h. Measure how far the catheter is inserted i. Connect the tip of the catheter with a 20 cc syringe filled with 0.9% NaCl 2-5 cc j. The needle is inserted approximately 1 finger forward medially, towards the ear on the opposite side k. The blood was sucked with the syringe l. The catheter continues to be inserted into the needle, continuing to be pushed until it reaches the superior vena cava or right atrium m. The mandrin was removed then the infusion was connected -> manometer with three way stopcock n. Catheter fixation to the skin o. Give Betadhin 10% p. Cover with sterile gauze and plaster IV. Indication The indication is to measure central venous pressure which describes right ventricular preload or right ventricular end-diastolic pressure so that it can provide information about blood volume, right ventricular image and venous capacity. V. Procedure 1. Preparation of tools: a. Measuring scale b. Connecting hose (manometer line) c. Standard infusion d. Three way stopcock e. U pipe f. Infusion set 2. How to assemble a. Connect the infusion set with 0.9% NaCl fluid b. Remove air from the infusion tube c. Connect the measuring scale with threeway stopcock d. Connect the threeway stopcock with the infusion hose e. Connect the manometer line with the three way stopcock f. Remove air from the manometer line g. Fill the liquid to the measuring scale up to 25 cm H2O h. Connect the manometer line with the installed catheter 3. How to measure a. Provide explanations to patients b. Adjust the patient's position c.Lavelling, is to align the location of the heart (right atrium) with the measuring scale or transducer d. The location of the heart can be determined by drawing a line where the fourth rib (ICS IV) meets the mid-axillary line e. Determine the CVP value by paying attention to the undulations on the manometer and the value read at the end of expiration f. Clean up the tools g. Notify the patient that the procedure has been completed VI. How to Assess CVP and Install a Manometer 1. How to Determine the Zero Point -The patient sleeps flat on his back -By using a water hose, the pliers are filled with ± half the water -> forming a circle with separate water boundaries -The patient's zero point is connected to the water level on one side of the hose. The other side is placed on the manometer. -The zero point of the manometer can be determined -The zero point of the manometer is the point that is the same height as the point where the superior V.cava flows, the right atrium and the inferior V.cava meet into one. 2. CVP assessment - Catheter, infusion, manometer connected to stopcock -> observe whether the infusion is running smoothly or not - The patient is supine We increase the infusion fluid into the manometer until it reaches the highest number -> take care not to let the fluid come out -We close the IV fluid, by turning the stopcock the manometer will enter the patient's body -The surface of the liquid in the manometer will fall and undulations occur according to the rhythm of breathing, falling (inspiration), rising (expiration) -The undulations stop -> there is the final limit -> CVP value -Value in number 7 -> CVP value 7 cmH2O -The infusion is run again after the CVP value is known 3. CVP Assessment and Its Clinical Significance CVP is very important for sufferers who experience shock and the assessment is as follows: a.Low CVP (< 4 cmH2O) b.Normal CVP (4 – 14 cmH2O) -Take blood or fluids carefully and monitor their effect on circulation.If the CVP is normal, the signs of shock are negative -> hypovolemic shock -If CVP increases, the sign of shock is positive -> septic shock, cardiogenic shock -Give blood or fluids by rapid drip. -If CVP is normal, signs of shock disappear -> hypovolemic shock -If CVP is normal, signs of shock increase -> septic shock c.High CVP (> 15 cmH2O) -Indicates a disturbance in the functioning of the heart (cardiac insufficiency). -Therapy: cardiotonic drugs (dopamine) VII. Factors that Influence CVP 1. Blood volume: - Total blood volume - The volume of blood contained in the vein - Speed of administering transfusions/fluids 2. Heart failure and cardiac insufficiency 3. Constriction of the veins caused by neurological factors 4. Use of vasopressor drugs 5. Increased intraperitoneal pressure and intrathoracic pressure, for example: - Post surgery illeus - Hematothorax - Pneumothorax - Use of a mechanical ventilator - Mediastinal emphysema 6. Pulmonary embolism 7. Pulmonary arterial hypertension 8. Superior vena cava syndrome 9. Chronic obstructive lung disease 10. Pericarditis constrictiva 11. Artevac ; If the catheter is blocked, the tip of the catheter is in the inferior jugular vein