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PRESSURE and
MONITORING
By:Jenivieve Garzo
BSN4
Tunneled CVC
Because no major valves lie at the junction of the vena cava and right atrium,
pressure at end diastole reflects back to the catheter.
The central venous (CV) line also provides access to a large vessel for rapid,
high-volume fluid administration and allows frequent blood withdrawal for
laboratory samples.
If
If
Equipment
For intermittent CVP monitoring: Disposable CVP manometer set leveling device (such as
a rod from a reusable CVP pole holder or a carpenters level or rule) additional stopcock (to
attach the CVP manometer to the catheter) extension tubing (if needed) I.V. pole I.V.
solution I.V. drip chamber and tubing dressing materials tape.
For continuous CVP monitoring: Pressure monitoring kit with disposable pressure
transducer leveling device bedside pressure module continuous I.V. flush solution 1 unit/1 to
2 ml of heparin flush solution pressure bag.
For using an intermittent CV line: Syringe with normal saline solution syringe with heparin
flush solution.
For removing a CV catheter: Sterile gloves suture removal set sterile gauze pads
povidone-iodine ointment dressing tape.
Implementation
Align the base of the manometer with the previously determined zero reference point by using a
leveling device.
Because CVP reflects right atrial pressure, you must align the right atrium (the zero reference point)
with the zero mark on the manometer.
To find the right atrium, locate the fourth intercostal space at the midaxillary line.
Mark the appropriate place on the patients chest so that all subsequent recordings will be
made using the same location.
If the patient cant tolerate a flat position, place him in semi-Fowlers position.
When the head of the bed is elevated, the phlebostatic axis remains constant but the midaxillary line
changes.
Use the same degree of elevation for all subsequent measurements.
Attach the water manometer to an I.V. pole or place it next to the patients chest.
Make sure the zero reference point is level with the right atrium.
All
openings blocked
Manometer
to patient
I.V.
solution to manometer
I.V.
solution to patient
I.V.
solution
bottle
Manometer
Zero point
Three-way stopcock
Turn the stopcock off to the patient, and slowly fill the
manometer with I.V. solution until the fluid level is 10 to 20 cm
H2O higher than the patients expected CVP value.
Dont overfill the tube because fluid that spills over the top can
become a source of contamination.
Turn the stopcock off to the I.V. solution and open to the patient.
When the fluid level comes to rest, it will fluctuate slightly with respirations.
Depending on the type of water manometer used, note the value either at the
bottom of the meniscus or at the midline of the small floating
ball.
After youve obtained the CVP value, turn the stopcock to resume the I.V.
infusion.
Make sure the stopcock is turned so that the I.V. solution port, CVP
column port, and patient port are open.
Be aware that with this stopcock position, infusion of the I.V. solution
increases CVP.
Therefore, expect higher readings than those taken with the stopcock
turned off to the I.V. solution.
If the I.V. solution infuses at a constant rate, CVP will change as the
patients condition changes, although the initial reading will be higher.
Read the CVP value from the digital display on the monitor,
and note the waveform.
Removing a CV line
Clean
Special considerations
Apply ointment, and then cover the site with a sterile gauze
dressing or a clear occlusive dressing.
Complications
Complications
Documentation
Film of CVC
http://www.youtube.com/watch?
v=Lb1Z3bndmA8&NR=1
http://www.youtube.com/watch?
v=p_0MQ75PK5U&NR=1
http://www.youtube.com/watch?
v=m7ppMf3JnoE&NR=1
http://www.youtube.com/watch?
v=nBNnS_0kC6o&NR=1
http://www.youtube.com/watch?v=Lb1Z3bndmA8
Film of CVC
http://www.youtube.com/watch?v=-
ycJPmyHLuM&NR=1
http://www.youtube.com/watch?
v=FXJvvSbgVTE&NR=1