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Central Venous Pressure Monitoring

A simple description of a highly technical medical procedure performed routinely in Intensive Care Units and other acute settings.

The use of central venous pressure monitoring in the intensive care and acute care setting is increasing. This is a measure of the venous pressure where the superior and inferior vena cava join prior to entering the right auricle of the heart.

Central Venous Pressure monitoring is more accurate then blood pressure monitoring because changes in circulating volume will be reflected in changes in CVP. The normal CVP is between 5 and 15 CMS of water.

Standard Equipment:

  1. CVP line
  2. Sterile gloves and masks
  3. Local anaesthetic
  4. Hypodermic needles
  5. Silk sutures with needle
  6. CVP insertion kit (with drape, chlorohexidine). .
  7. Manometer / transducer
  8. Normal saline or heparinised saline according to Hospital policy
  9. Electronic manometer or manual Monitoring equipment
  10. Scissors, sterile dressings

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.

Generally, when the CVP is rising to unhealthy levels the patient may display difficulty with breathing. Conversely, when the CVP is falling there may be a decrease in urinary output and the patient may complain of feeling excessively thirsty. To correct over hydration, as illustrated by a rising CVP the physician may choose to restrict fluids or to administer a diuretic. To deal with a falling CVP the physician might choose to give the patient more fluids or blood as the case may be.

Most institutions have Policies and Procedure manuals which state the indications for the insertion of a CVP monitoring line.

Model with two CVPs

<img alt=”" src=”http://images.stanzapub.com/readers/healthmad/2007/04/03/23758_0.jpg” /

Prior to the insertion of a CVP line an accurate assessment of the patient must me made. A history of the patient may be obtained from the patient, family, notes of previous admissions and the authority who brought the patient to the Hospital.

It is important to explain the procedure to the patient to obtain his or her history. Local anesthetic should be used where the patient does not have an allergy to it. Placing the patient in a supine position is usually sufficient. In some cases where the patient is hypovolumic the trendelenberg position will help dilate the veins in the upper parts of the body and make it easier for the physician to insert the cannula.

Appropriate draping is important to maintain sterility and patient cooperation. In some situations it may be advisable to use a mild sedative to limit pain, awareness of the procedure and keep the patient calm.

After insertion of a CVP line it is usual to have a chest x-ray. This will confirm correct placement of the CVP line.

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  1. Thank you for the information and picture above. However, you have not told the complete story. Although the central lines above can both be used to measure central venous pressure, that is rarely their primary purpose. The double lumen line arrow catheter that appears to be placed in a simulated internal jugular vein, resembles a dialysis catheter. The large lumens and blue clamp to the distal infusion port and red clamp to proximal withdrawal port suggests to me that this is a dialysis catheter. Although the correct port can be attached to a CVP bedside monitor for readings, it is not the normal catheter that we use in our facility for this.

    The lower catheter that resembles the Arrow triple lumen line is frequently what is used to obtain CVP readings. It contains 3 ports, distal, proximal and medial ports. An X-ray is used to verify the position of this catheter to obtain a reliable CVP reading by using the correct CVP monitor set up. The “old” manual glass or plastic manometer can be used for this procedure, however, in my opinion, the bedside monitor is a safer method.

  2. Good Day Ms. Mary Wood,

    Thank you for reading my article and commenting upon it.

    These short blogs do not give the full picture and are not designed to replace professional knowledge.

    Real life is much more complicated! There is a lot of infromation on the web and numerous books have been written about venous pressure, blood pressure, preload, after load etc.

    I do not claim to write addressing all issues.

    Would love to continue this this discussion. I had a colleague, in Scotland, by that name. I wonder. if it’s you?

    Bye for now. Thank You.

  3. Great article. I am a first year student nurse. This is easy to understand. I wish more books and articles were written in a simple manner.

  4. Thank You for your very sincere comments. They are appreciated. You have made my day.

    Shergill

  5. I like the way you’ve presented the information, in a simple manner with a picture to illustrate your point. However, you’ve written more about the insertion of the line rather than monitoring of the patient’s CVP

  6. I like the way you’ve presented the information, in a simple manner with a picture to illustrate your point. However, you’ve written more about the insertion of the line rather than monitoring of the patient’s CVP

  7. Your explanation is clear and simple. You must be a teacher.

  8. Yes, I am. I try to keep these articles as simple as I can because I am aiming to help members of the public who may or may not have technical knowldege about this type of subject matter. I am aware that some members of the public are looking for information in a form which is easy to understand. I cannot say that I am successful all the time.

    Thank You for reading and commenting on my articles. It is appreciated.

    Good Luck and best wishes.

  9. Good Day victoria,

    I will address you concern in a follow up article where I will go into more detail about how to measure the CVP and why it is done.

    Thank You for your comments and taking the time read my ariticle(s). They are appreciated.

    Bye for now.

  10. Using the triple lumen catheter to measure CVP does it matter which port (proximal, medial, or distal) that the tubing and transducer are attached to do the monitoring?

  11. Good Day Janice,

    Thank You for asking this question. I will publish a short article with the different ports labelled so that you will know which port is for which purpose. The earliest CVP catheters were single lumen and therefore they were used for measuring CVP and giving medications.

    Bye for now.
    Shergill

  12. great article. how do u address the debates as to whether immediate cxr are necessary after all cvp insertions? wud luv to hear soon from u..

  13. i’m a nurse.i’m confused about cvp reading as when we measure cvp, sometimes it exceed and in some other cases ,reading goes to 0 level and we don’t feel there any clinical problems as pt seems comfortable. is this alarming?

  14. Sorry for not having responded to your queries for a long time.

    Response to Victoria’s Comments:

    Very Good a assessment of the article. I will rectify the situation and update this article with more information.

    Shergill

  15. Response to Ranjan Sapkota’s posting.

    “Great article. How do u address the debates as to whether immediate cxr are necessary after all cvp insertions? wud luv to hear soon from u..”

    Ranjan, I am a lecturer in a University. From my perspective one must never place the patient at risk. Yes, I am aware that every procedure bears risk. In this equation the benefit has to be taken into consideration.

    After looking at the risk to benefit ratio one has to look at other factors. These include: patient’s wishes, family’s wishes, patient’s tolerance for the procedure, economics, staff skill mix etc

    Post insertion x-rays carry a certain amount of risk. Not doing an x-ray carries a risk. Relatively speaking,it is safer for the patient to have an x-ray done. I know the staffing, economic, exposure and discomfort involved. On the whole, I feel, it is safer to have an x-ray done.

    I would be comfortable if the physicain who inserrted the CVP cannula said to me to, “start it” in the absence of an x-ray.

    Bye for now.
    Shergill

  16. you have done a fair job. you must elaborate it further.

  17. i like it too ,,, simple n easy :)

  18. It’s helpful..just like a refresher course for the day ;-}

  19. thanks and great job done… would appreciate if you can provide some information about the waveform and the explaination.

  20. thanks and great job done… would appreciate if you can provide some information about the waveform and the explaination.

  21. Good Day Jothy, amira, sonu, ranjan and all otherw who wanted an improved version of CVP.

    Are you a student at CDU? I seem to have haeard that name. I have today submitted an improved version on how to do a CVP.

    Bye for now.
    Shergill.

  22. Good Day Jothy, Pauline, Sonu, Amira, Ranajan, Mg and Janice,

    I have spent a little more time on refining this article on CVP. Also, since this article has been read extensively I have made it a little more accurate with lots of details and pictures from the real world of nursing. I have personally taken all these pictures.

    I hope you enjoy this article and it enhances your knowledge about this procedure. Please feel free to send feedback again.

    Shergill

  23. thank you Shergill your article was very helpful. have a great day

  24. Good Day Sonja,

    Thank you for reading and commenting on my CVP atricle. The article entitled CVP for nurses is the most detailed version. You will find it even more helpful.

  25. Hello Shergill can you please give some purposes of Central Venous Pressure Monitoring? It would be very nice if you can state some. Thank You

  26. Good Day Reynan,

    Thank You for reading this article and commenting upon it.

    The purposes (reasons) for doing CVP are covered in my other article at: http://www.healthmad.com/Nursing/Central-Venous-Pressure-for-Nurses.103179

    Shergill.

  27. Hi Shergill, thank you very much for this variable information, could u Plz tell me where can i find a good visual resourse for this procedure, cuz i have never seen it before.

  28. Good Day Anas,

    Have you read my other articles about CVP. These articles can be read at healthmad

  29. Hi, I am a nurse lecturer in Malaysia. Your explanation is good. Thank you for explaning in a simple term.

  30. Hi Kawan,

    Apa Khabar? Saya pun Orang Malaysia. Saya ini Melaka punya orang lah!

    English translation:

    Hi Mate,

    What’s new? I am also a person of Malaysia. Malacca boy!

  31. hi..

    I have a return demonstration about CVP tomorrow i cant understand the procedure in my manual..its so hard to understand..You know return demonstration every move with rationale..I am 3rd year nursing student in Philippines..I want to get the highest grade thats why im searching about it..so thank you for the easy explanation…

  32. its very nice description but plz tell us is there any other way to measure central venous pressure a part from using manometer?

  33. nice article! is there any non -invasive way to measure CVP? I hv heard about sonography..how accurate is that?

  34. Yes, CVP measurement using sonography is valid method of doing CVP measurement. However, it is less accurate. There is an article in all nurses.com

  35. thnx for ur information,but i wished it was more complete,and detailed anyway

  36. http://www.springerlink.com/content/r338374×81756450/

    paste this link to a recent study on the effectiveness of measuring CVP through the Distal port of a triple lumen and delivering NS or Nor epi through the proximal port.
    No change in readings was discovered….
    You can measure CVP using the distal port and administer fluids at the same time through the proximal port.

    good luck!

  37. Great article and its more understandable, but you have concentrated more on insertion rather than monitoring bt other wise big ups

  38. Hi Boitumelo,

    Thank You for your comments. I agree. I will try and improve those deficiencies. Thanks once again.

  39. Hi Sarah,

    Thank You for your comments. They are helpful. I have published other articles which contain more details etc.
    Hope you can find them. Just google search CVP and you will find them. Alternatively you can search Shergill’s articles and you will find them too.

  40. l need someone to help me with details on how l can get to buy a Central Venous Pressure monitor, it urgently needed by my hospital my contact detail are toibdabiri2002@yahoo.com

  41. Hi Shergill… Proud of you… Nice article! I\’m Shamsul from Malaysia too! Now I\’m in IJN… My son baru selesai buat ASD and VSD closure.. Now still in ICU. Just want to ask you… His CVP reading is 7 to 10… IS IT OK…? Hope to hear from you as soon as posible. Tq.

  42. Hi Shergill… Proud of you… Nice article! I\\\’m Shamsul from Malaysia too! Now I\\\’m in IJN… My son baru selesai buat ASD and VSD closure.. Now still in ICU. Just want to ask you… His CVP reading is 7 to 10… IS IT OK…? Hope to hear from you as soon as posible. Tq.

  43. Hi Shamsul,

    A CVP of 7 to 10 is great. However, it is not reasonable to by one set of parameters to evaluate the progress of any patient. Is he alright clinically, “Overall?”

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