Central Venous Pressure Monitoring

Central venous pressure is considered a direct measurement of the blood

pressure in the right atrium and vena cava. It is acquired by threading a
central venous catheter (subclavian double lumen central line shown) into any
of several large veins. It is threaded so that the tip of the catheter rests in the
lower third of the superior vena cava. The pressure monitoring assembly is
attached to the distal port of a multilumen central vein catheter.

Assisting with CVP placement

 Adhere to institutional Policy and

Procedure.
 Obtain history and assess the
patient.
 Explain the procedure to the
patient, include:
o local anesthetic
o trendelenberg positioning
o draping
o limit movement
o need to maintain sterile
field.
o post procedure chest X-
ray
 Obtain a sterile, flushed and
pressurized transducer
assembly
 Obtain the catheter size, style
and length ordered.
 Obtain supplies:
o Masks
o Sterile gloves
o Line insertion kit
o Heparin flush per policy
 Position patient supine on bed
capable of trendelenberg
position
 Prepare for post procedure chest
X-ray

The CVP catheter is an important tool used to assess right ventricular function
and systemic fluid status.
  Normal CVP is 2-6 mm Hg.
 CVP is elevated by :
o overhydration which increases venous return
o heart failure or PA stenosis which limit venous outflow and lead to
venous congestion
o positive pressure breathing, straining,
 CVP decreases with:
o hypovolemic shock from hemorrhage, fluid shift, dehydration
o negative pressure breathing which occurs when the patient
demonstrates retractions or mechanical negative pressure which
is sometimes used for high spinal cord injuries.

The CVP catheter is also an important treatment tool which allows for:

 Rapid infusion
 Infusion of hypertonic solutions and medications that could damage
veins
 Serial venous blood a

There are two ways to read a CVP waveform:

1. Find the mean of the A wave.

  read the high point of the A wave
 read the low point of the A wave
 add the high point to the low point
 divide the sum by 2
 the result is the mean CVP

The A wave starts just after the P wave ends and represents
the atrial contraction. The high point of the A wave is the
atrial pressure at maximum contraction. During the A wave
the atrial pressure is greater than the ventricular diastolic
pressure. At that point, the atrium is contracted, the tricuspid
is open. Therefore, the high point of the A wave closely
parallels the right ventricular end diastolic pressure.
Remember, when the tricuspid valve is open and the right
ventricle is full, the ventricle, atrium and vena cavae are all
connected. Therefore, that point is the CVP.

2. Find the Z-point.

 Find the Z-point which occurs mid to end QRS

 Read the Z-point

The Z-point coincides with the middle to end of the

QRS wave. It occurs just before closure of the
tricuspid valve. Therefore, it is a good indicator of
right ventricular end diastolic pressure. The Z-point is
useful when A waves are not visible, as in atrial
fibrillation. (The c-wave occurs at closure of the
tricuspid valve. The crest of the c-wave is the atrial
pressure increase caused by the tricuspid valve
bulging back into the atrium.)