CVP

Question 1

Central venous catheter

Answer 1

Single lumen catheter inserted into a large central vein, such as internal jugular vein.
advanced until it rests in the superior vena cava or in the right atrium
Measures the pressures near the right atrium
Used in critically ill patients, monitors CVP or RAP

Question 2

Indications for invasive central venous pressure monitoring

Answer 2

• active bleeding
  recent surgery
  trauma
  shock
  sepsis
  renal failure

Question 3

Complications with CVP catheters

Answer 3

Pneumothorax
Thrombosis
Hemorrhage
Air embolism
Infections
Fluid overload

Question 4

CVP measurements with monitoring equipment

Answer 4

Using a recalibrated manometer, normal value: 4-8cmH2O
Using a pressure transducer system, normal values 2-6mmHg

Question 5

Situations that alters intrathoracic pressure

Answer 5

Spontaneous inspiration and mechanical ventilation
- CVP decreases with spontaneous inspiration and increases with mechanical ventilation
CVP measurement should be read at the end of expiration for spontaneously breathing patient

Question 6

Conditions causing increased CVP

Answer 6

Elevated intravascular volume
High CO
Cardiac tamponade
Pulmonary hypertension
Vasopressor administration
RV infarct, RV failure
Constrictive pericarditis
Chronic left ventricular failure

Question 7

Conditions causing decreased CVP

Answer 7

Reduced intravascular volume/hypovolemia
Decreased mean systemic pressures
Early shock states / vasodilation (decrease venous tone)
Drugs
Leaks or air in pressure line
Improper transducer placement

Question 8

Right atrial pressure monitoring: Waveform analysis

Answer 8

A wave, C wave, V wave, X decent, Y decent

Question 9

A wave

Answer 9

Rise in pressure due to atrial contraction
Corresponds to PR interval

Question 10

C wave

Answer 10

Rise in pressure due to ventricular contraction and closure of the tricuspid valve
Corresponds to RST interval

Question 11

v wave

Answer 11

rise in pressure during atrial filling
Corresponds to T wave

Question 12

x decent

Answer 12

Fall in pressure due to atrial relaxation

Question 13

y decent

Answer 13

fall in pressure due to opening of the tricuspid valve. emptying of RA into RV and onset of ventricular filling