Io 8 S 9 Dfxtywgs 86 Fy

CENTRAL VENOUS PRESSURE
LINE MONITORING
INTRODUCTION
• The central venous pressure (CVP) is the pressure

measured in the central veins close to the heart.
• It indicates mean right atrial pressure and is
frequently used as an estimate of right ventricular
preload.
• CVP reflects the amount of blood returning to the
heart and the ability of the heart to pump the blood
into the arterial system
INTRODUCTION Cont’
• It is the pressure measured at the junction of the

superior vena cava and the right atrium.
• It reflects the driving force for filling of the right

atrium & ventricle.
• Normal CVP in an awake spontaneously breathing

patient : 1-7 mmHg or 5-10 cm H2O.
TYPES OF CENTRAL LINE
• SINGLE LUMEN
• DOUBLE LUMEN
• TRIPLE LUMEN
• QUADRUPLE LUMEN
• QUINTUPLE LUMEN
• PERIPHERALLY INSERTED CENTRAL CATHETERS
(PICCS)
Single, Double, and Triple Lumen Central
Lines
Indications Central Venous Line (CVL)
• Major operative procedures involving large fluid

shifts or blood loss
• Intravascular volume assessment when urine output
is not reliable or unavailable
• Temporary Hemodialysis
• Surgical procedures with a high risk for air embolism,
CVP catheter may be used to aspirate intracardiac air
Indications Central Venus Line (CVL) CONT’
• Frequent venous blood sampling, Inadequate

peripheral intravenous access
• Temporary pacing
• Venous access for vasoactive or irritating drugs &
Chronic drug administration
• Rapid infusion of intravenous fluids (using large
cannulae)
• Total parenteral nutrition
Relative Contraindications
• Bleeding disorders (platelet counts <50,000,

bleeding is uncommon and easily managed).
• Anticoagulation or thrombolytic therapy.
• Combative patients.
• Distorted local anatomy.
• Cellulitis, burns, severe dermatitis at site.
• Vasculitis.
Peripherally Inserted Central Catheters
(PICCs)
• LOCATION OR SITE OF
INSERTION
• INDICATIONS
• CONTRAINDICATIONS
• BENEFITS AND RISKS
PICC LINE
PICC LINE INTRODUCTION
• A Peripherally Inserted Central Catheter (PICC)
is a small gauge catheter that is inserted
peripherally but the tip sits in the central
venous circulation in the lower 1/3 of the
superior vena cava.
• It is suitable for long term use and there are
no restrictions for age, or gender.
SITE’S OF INSERTION OF PICC LINE
• PICCs are commonly placed at or above the
antecubital space in the following veins;
 Cephalic vein
 Basilic vein
 Medial-cubital vein
INDICATIONS FOR PICC LINE INSERTION
• PICC lines are suitable for many situations when
access is limited or expected to last longer than 2
weeks.
• Compromised/Inadequate peripheral access
• Infusion of hyperosmolar solutions or solutions with
high acidity or alkalinity
(e.g. Total Parenteral Nutrition)
• Infusion of vesicant or irritant agents
(Inotropes, Chemotherapy)
• Short or long term intravenous therapy
(e.g. Antibiotics)
CONTRAINDICATIONS FOR PICC INSERTION
• Previous upper extremity venous thrombosis (DVT)

• Trauma or vascular surgeries at or near the site of
insertion
• Presence of a device related infection, cellulitis, or
bacteremia at or near the insertion site
• Lymphedema.
• Mastectomy surgery with axillary dissection +/-
lymphedema on affected side (unless urgent
condition requires it)
• Allergy to materials
• Irradiation of insertion site
Sites for insertion of CVL
• Internal Jugular
• Subclavian
• Femoral
• External Jugular
• Basilic
• Axillary
Right IJV is Preferred
• Consistent, predictable anatomy

• Alignment with RA
• Palpable landmark and high success rate
• No thoracic duct injury
CVL Insertion
• Equipment.
• Patient position.
• Procedure.
• After insertion
Equipment
• Sterile gloves, gown, suture pack.

• Iodine solution.
• 10 ml syringe, 2% lidocaine, 10 ml N.S.
• Catheter special size.
• H2O manometer.
• Flush solution with complete CVP line.
• Dressing set.
Patient Position
• Patient is moved to the side of the bed so physician
would not lean over.
• The bed is high enough so physician would not have
to stoop over.
• Patient should be flat without a pillow,
Trendelenburg position if patient is hypovolemic.
• The head is turned away from the side of the
procedure.
• Wrist restraints if necessary.
Procedure
Skin preparation:
• Prepare before putting sterile gloves
• Allow time for the sterilizing agent to dry
Drape:
• Large enough and Handed sterilely by the assistant.
• Hole in the area of placement.
Prepare the tray:
• Prepare the equipment before starting.
Anesthesia:
• Use local anesthesia with lidocaine
USING THE CENTRAL LINE
• Flush it, before and after use( with NS).
• Some places also require heparin flush.
• Close clamps when not in use.
• Dressing is usually changed every days.
• Line can be used for blood drawing –withdraw
and waste 10 cc, then withdraw blood for
samples.
• If port becomes clotted, do not use –
sometimes ports can be opened up.
Immediately Complications of Insertion
CVL
• Hemothorax.
• Pneumothorax (most common).
• Bleeding
• Arterial puncture.
• Vessel erosion
• Nerve Injury.
• Dysrhythmias.
• Catheter malplacement.
• Embolus.
• Cardiac tamponade.
Delayed Complications
• Dysrhythmias
• Infection (“Femoral > IJ > subclavian”)
• Catheter malplacement.
• Vessel erosion.
• Embolus.
• Thrombosis
Factors Affecting CVP
•Cardiac Function
•Blood Volume
•Capacitance of vessel
•Intrathoracic Pressure
•Intraperitoneal
pressure
Causes for Increase in CVP
• Over hydration.
• Right-sided heart failure.
• Constrictive pericarditis.
• Pulmonary hypertension.
• Tricuspid stenosis and regurgitation.
• Stroke volume is high.
Causes for Increase in CVP CONT’
Decrease of CVP
• Hypovolemia.
• Decreased venous return.
• Excessive veno or vasodilation.
• Shock.
• If the measure is less than 5 cm water that
mean that the circulating volume is decrease.
Decrease of CVP CONT
CENTRAL VENOUS PRESSURE
MONITORING
Methods to measure CVP
Indirect assessment:
• Inspection of jugular venous pulsations in the
neck.
Direct assessment:
• Fluid filled manometer connected to central
venous catheter.
• Calibrated transducer.
Inspection of jugular venous pulsations in the
neck.
• No valve between Right atrium & Internal
Jugular Vein.
• Degree of distention & venous wave form
reflects information about cardiac function
Measuring central venous pressure
Using a manometer
• Line up the manometer

arm with the
phlebostatic axis
ensuring that the
bubble is between the
two lines of the spirit
level
Phlebostatic Axis
4th intercostal space, mid-

axillary line
Level of the atria

• Move the manometer
scale up and down to
allow the bubble to be
aligned with zero on the
scale. This is referred to
as 'zeroing the
manometer
• Turn the three-way tap
off to the patient and
open to the manometer
• Open the IV fluid bag
and slowly fill the
manometer to a level
higher than the
expected CVP
• Turn off the flow from
the fluid bag and open
the three-way tap from
the manometer to the
patient
The fluid level inside the
manometer should fall
until gravity equals the
pressure in the central
veins
• When the fluid stops
falling the CVP
measurement can be
read. If the fluid moves
with the patient's
breathing, read the
measurement from the
lower number.
• Turn the tap off to the
manometer veins
• Document the
measurement and
report any changes or
abnormalities
Measuring central venous pressure
Using a transducer
• Turn the tap off to the

patient and open to the
air by removing the cap
from the three-way port
opening the system to
the atmosphere.
• Press the zero button
on the monitor and wait
while calibration occurs.
• When 'zeroed' is
displayed on the
monitor, replace the cap
on the three-way tap
and turn the tap on to
the patient.
• Observe the CVP trace
on the monitor. The
waveform undulates as
the right atrium
contracts and relaxes,
emptying and filling
with blood. (light blue
in this image)
THANK YOU

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CENTRAL VENOUS PRESSURE

• The central venous pressure (CVP) is the pressure

• It is the pressure measured at the junction of the

• It reflects the driving force for filling of the right

• Normal CVP in an awake spontaneously breathing

• Major operative procedures involving large fluid

• Frequent venous blood sampling, Inadequate

• Bleeding disorders (platelet counts <50,000,

• Previous upper extremity venous thrombosis (DVT)

• Consistent, predictable anatomy

• Sterile gloves, gown, suture pack.

• Line up the manometer

4th intercostal space, mid-

Level of the atria

• Turn the tap off to the

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