Where is a CVP line inserted?
The internal jugular, subclavian vein or femoral vein.
What are the two purposes of a CVP line?
Measure the filling pressure of the right atrium and administer fluids, bloods, drugs, parenteral nutrition and sample blood.
How many lumens does a CVP set have?
2-5, most commonly 3 or 4.
What do you need for a CVP line set-up?
- Drip stand
- 500ml/1L bag of sodium chloride 0.9%
- Pressure bag
- CVP line
- Transducer plaque
- CVP line monitor cable
- CVP stickers
What position should the patient be in for the procedure?
Trendelenburg (head-down tilt).
What sterile items are needed for the procedure?
- CVP set
- 30/40ml saline
- Size 11 blade
- Scissors
- Silk suture
- Transparent dressing
- Ultrasound sheath and lubricant
Why should the CVP catheter be flushed?
- Prevent air entering patient’s circulatory system
- Prevent blood loss when inserted
What observation should you watch during insertion of guidewire?
ECG – look for irregular beats.
The transducer set should be level to what?
The patient’s heart.
What is the order of the CVP waveform?
A, C, X, V, Y.
What is the A wave?
Right atrial contraction.
What is the C wave?
Cusp of tricuspid valve protruding through right atrium, right ventricle contracts.
What is the X wave/descent?
Downward movement of contracting right ventricle.
What is the V wave?
Back pressure from blood filling right atrium.
What is the Y wave?
Tricuspid valve opens in early ventricular diastole.
What does a loss of Y wave suggest?
Tamponade – restriction to right ventricular filling.
How is CVP expressed?
Millimetres of mercury (mmHg) or centimetres above atmospheric pressure (cmH₂O).
1mmHg = XXcmH₂O?
1.36cmH₂O.
What is a normal CVP?
2-6mmHg.
What elevates CVP?
- Overhydration
- Heart failure or pulmonary artery stenosis
- Positive pressure breathing, straining.
What is pulmonary artery stenosis?
A condition where there is a narrowing or obstruction of the pulmonary artery.
What decreases CVP?
- Hypovolaemic shock from haemorrhage, fluid shift, dehydration
- Negative pressure breathing.
What are the risks of CVP line insertion?
- Pain
- Bleeding
- Thrombosis
- Infection
- Air embolus
- Cardiovascular complications
- Catheter fracture.
Which cardiovascular complications are possible?
- Tamponade
- Fatal arrhythmia.
