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Central Venous Pressure for Nurses

Central Venous Pressure monitoring is a frequently done procedure in many hospitals. There are many conflicting and poorly understood principles and practices surrounding the measurement of Central Venous Pressures. This article is written by a Lecturer in Health Sciences and helps in explaining some of the "not so clear issues". This article is for the benefit of student nurses and registered nurses.

Central Venous Pressure (CVP for short) is defined as the pressure of blood in the thoracic vena cava just before it (the blood) enters the right atrium of the heart. Normal CVP is 5 to 10 cm H2O.

CVP measurements are important in clinical cardiology because the CVP is a major determinant of the filling pressure of the right ventricle of the heart. The filling pressure of the right ventricle determines the stroke volume i.e. the amount of blood pumped with each contraction of the heart.

Background: Central Venous Pressure is an accurate indicator of the amount of blood returning to the heart from the head, body and limbs via the superior and inferior vena cava. If and when there is blood loss then the CVP reading will be altered (will fall) almost immediately as the amount of blood returning to the heart will have decreased. Central Venous Pressure is also an accurate indicator of the ability of the heart (myocardial pump strength) to pump out blood to maintain normal blood pressure and tissue perfusion. Last but not least, the CVP is an accurate indicator of right ventricular end diastolic volume. In most institutions CVP is measured in cm of water (H2O). On this scale the normal value of CVP is 5 to 10 cm H2O. Some, (very few) institutions measure CVP in mm. Hg (millimetres of mercury). On this scale the normal value is approximately 4 to 8 mm Hg.

Central Venous Pressure in measured using a sterile indwelling central venous catheter (CVC). One end of the CVC is attached to a manometer or an electronic transducer, computer and monitor. Ultrasound may be used to guide CVC insertion. In the facility where I used to work experienced practitioners went in blind. Usually they were successful in locating the desired blood vessels without difficulty.

Central Venous Pressure monitoring is more accurate then blood pressure monitoring because changes in circulating volume will be reflected in changes in CVP values as soon as there is blood loss. Nurses and Nursing students will already know that in the first stage of shock, following blood loss, the compensatory mechanisms “adjust the blood pressure to normal levels”. Consequently, blood pressure readings will remain within the normal range after blood loss but not the CVP.

When there is overloading of the circulatory system or there is heart failure the CVP rises. However, when there is dehydration (e.g. diabetes insipidus), fluid loss due to bleeding or shifting of fluids within the body compartments (e.g. shock) then the CVP will fall. We have studied that “fluid challenges” in the early stages of shock can prevent shock and subsequent death of a patient.

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  1. A Great article! You need to consider writing a book.

  2. Thank u, and I’m waiting for the next article

  3. Good Day Ika,
    Thank you for reading and commenting on my article.
    I am currently working on two articles on Pain Management. One is a short three to five page article on essential principles of pain management. The other article is about everything a nurse should know about pain management.
    Thank You for your comments. They are appreciated. It is nice to know that there are real people out there.
    Lastly, do you have any topic you will like me to write on?
    Shergill.

  4. Ei, Good Day, I’m a nursing student and last night i have been exposed with a patient with a CVP line for the first time. I don’t know what CVP means or the nature and purpose of it. Glad that i have come across with your article. Simple and very easy to understand. Thank you!

    By the way, I’m from the Philippines, just wanna let you know that you have a fan in this part of the world.

  5. Thank You for your comments. I am so pleased to hear that my article was able to help you. Remember, this is just the beginning. Nursing is a very challenging profession.

    Good News: Lots of jobs everywhere. Even outside conventional hospital jobs.

    Feel free to communicate with me. Use the latest articles only because I have published alot, I do not follow the comments on my older articles.

    Good Luck with you career. Always care for your patient. He/She deserves all that we as nurses can give.

  6. Can you tell me a specific situation where a CVP would be helpful in determining patient care?

  7. Good Day Jean,
    There are many situations where the patients CVP would be very helpful when caring for a Patient.
    a. All patients with internal bleeding disorders will benefit from CVP readings. The CVP will drop before peripherally measured blood pressure change becomes noticeable. Earlier intervention will result in a more favourable outcome for the patient.
    b. All patients with renal failure will benefit from CVP readings. In these situations the CVP readings will rise due to circulatory overload. Appropriate intervention to correct the fluid overload will prevent the patient from becoming SOB or from dying.
    c. All patients with CHF will benefit from CVP readings because circulatory overload can be detected early and treated early.
    d. All patients receiving blood transfusions will benefit from CVP readings because blood transfusion rate can be titrated to the patients needs.
    e. All patients benefit from this procedure during major surgery where it is necessary to maintain an accurate balance between blood loss and blood replacement.
    f. All patients on dialysis benefit from this procedure.
    g. All patients who are on large doses of diuretics benefit from this procedure.
    I hope this answers your question. Otherwise feel free to communicate again.

  8. Hello YANEE. My Fan! GREAT TO HEAR FROM YOU!

    Please drop me a line. I do check all my postings on a regular basis.

    Shergill!

  9. A colleague and me were looking for an article on CVP measurement for our new critical care nurses. After doing a traditional literature search, I did an online (”Googe”) search and found this. It is just what our nurses need. Thank you very much.

    Barbara Pope
    popeb@einstein.edu

  10. Good Day Barbara,

    I appreciate the fact that you have taken the trouble to contact me. Triond wrote to me too and I did say to them that they could give you my email address.

    Barbara, I am a Nurse Educator in Australia and my students read my work frequently. I am fortunate in that my articles are read extensively. With your qualifications you could be writing and publishing here. Our global students will be able to benefit from our efforts.

    Sometimes I feel that we as nurses are not doing enough to educate the general public. You just need to look around at some to the lies that are published.

    I write on political issues, nursing issues, male infant circumcision and much more.

    When you read my profile you will be able to locate me. I lecture at a University in Darwin, Australia.

  11. thanx a lot….youp article help me a lot in my assignment

  12. Good Day el,

    Thank you for reading my article and “communicating with me”.

    I am glad my article helped you. If there is a specific topic you need me to write on please let me know. Please write to me on my latest article(s) for prompt response.

  13. i enjoyed your article; it was very informative. but can you please shed some light on my query?

    if you happen to know what are whats of the different ports of the Central Venous Pressure — the three way lumen specifically for this matter– the distal, medial and proximal ports. i mean where are do you extract blood from, where do you push the medications and stuffs like those.

    thanks in advance.

    jennifer cruz (uganda)

  14. very interesting website wherein we could post comments. i hope to here more in new trends in emergency nursing. thanks…

  15. Good Day Grace,

    The newest “trend” is not really a trend. It is more a sensitivity to an existing issue.

    Patient rights include, “not tucking the bedsheet in a restrictive manner”. A restrictive is defined as any manner which reduces the patients ability to get out of bed.

    Shergill.

  16. Thanks for writing this article. It is a great help to better understand CVP.

  17. nice article!
    also, u shud write about the numbers of persons using this mehod world wide for the incidence and prevalence point of view

  18. thank you soo much for a concise information that you have parted us…

    more powers and Godblezz…

  19. heloo..im yan-yan…a nursing student,and last night i was able to assosy doctor in insertion of CVP LINE..great that iv read ur articles hir,i was able to understand waht CVP insertion a lot…..but wait,,,,can u give some indication of it..just a very shot summmary…thank you=)and GODBLESS

  20. Hi iam a nurse.this message is realy helpful.and if you can mention that which port (lumen)is used for what then it will be more useful for the newcomers in ICU. Thanks

  21. “A pressured bag of saline is hung up and connected to the CVC line, the transducer and the CVP lumen of the CVC line. This is generally the proximal lumen – most suitable for measuring the CVP”

    Cook insrument recommended to use the distal port for “the whole blood or blood product delivery and sampling, any situation requiring greater flow rate, CVP monitoring, Medication delivery”. Distal lumen is more close to the RA but will the flow of the infusion affect the readings if a distal lumen is used?

    Any final verdict if this contradicts with the manufacturer’s recommendation?

    Reference from:
    http://www.cookmedical.com/cc/lumen.do?label=Lumen&file=cc_lumen.jsp&id=4857

  22. thnk u so much,this page was very useful and perfect,ill use it in my confrence tomorrow…and ill suggest ur page to my classmates…i got all the information i need for CVP.

  23. Hi all nurses and students,

    Thank You for supporting and encouraging me. I love to read your comments. Please do not feel that these comments go unread.

    Thanks.

  24. hi shergill
    i m a nurse …. its was really a helpful artical…
    thank u …

  25. very nice!…it helped me a lot with my return demonstration…thank you!

  26. hallo shergill

    your article is very nice it helps me alot. by the way iam a student nurse from philippines. tnx alot hope you will publish more articles that are educational and could help students and other people who are in need.

  27. informative… thumbz up!! looking forward for other hospital-procedure-related articlez…

    tnx.

  28. Hi Rakshya, Kashy, Clinkz and Ace,

    Thank you for your comments. Much appreciated.

    Personal advice: Work hard, go home happy and you will be good nurses for many years to come. It is a good profession. You help others and do not have to ask them to pay you.

  29. I am glad that I found this. Very informative.
    One question that I wonder about is:
    Does the lumen size impact the accuracy of the CVP reading? We use triple lumen catheters placed in the IJ or subclavian AND we also use PICCs that are of course placed in the arm. The lumen sizes vary between all of these. Any concerns related to that?
    THANKS.

    Gwen

  30. Thank you for your informative article. l have one question to ask: Why do we remove CVC on expiration? l would greatly appreciate you clarification.

  31. Thank you for this article. I found it to be systematically presented and easily understood.

  32. Im a mdecial student from Pakistan, and just wanted to let you know that your article saved my day here. I was required to read up extensively on CVP and present it to my classmates before we could all see the insertion and here I found everything I needed in a single article. Thank you :)

  33. Hi Amina,

    You will not believe this but it is true. I was born in Punjab. I am so glad that this article helped you. Thank you for your feedback. It has made me feel happy. Good luck with your chosen profession, it is a noble one. I hope you will help all mankind with your skills.

  34. i’m student nurse from Malaysia.
    thank you for this great article.
    it was all there. ;D

  35. im student nurse.. thank to great article
    so ex…

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