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CVP Monitoring
ANP1 Exam 3
Question | Answer |
---|---|
CVP meaasures | ~RAP ~Right end-diastolic volume ~best indicator of right atrial pre-load |
CVP indications | 1. fluid mgmt hypovolemia & shock 2. assess venous return & volume status 3. surgery w/ large fluid shifts/blood loss 4. caustic or TPN infusions 5. aspiration of air emboli 6. transvenous pacing 7. need venous access 8. sepsis, HF, Resp. Fa |
CVP contraindications | 1. renal cell tumor extension to RA 2. fungating TV vegetation 3. IJ CI w/ anticoagulants & ipsilateral carotid endart (poss carotid puncture) |
CVP location | catheter tip just above SVC/RA junction |
CVP SC | 1. high risk of pneumo during insertion 2. line-related infection with long duration |
CVP IJ | 1. RIJ comb accessibility & safety 2. LIJ increased risk: vascular erosion, pleural effusion, chylothorax (thoracic duct wraps around IJ on left) |
normal CVP range | 2-6 |
when to read CVP | ~end-expiration ~after 'a' wave ~before 'c' wave ~reflect pre-systolic RV pressure |
CVP risks | 1. infection 2. air / thrombus embolism 3. dysrhythmias 4. hematoma 5. pneumo 6. hemothorax 7. hydro/chylothorax 8. cardiac perf 9. tamponade 10. artery/nerve trauma 11. thrombosis |
CVP waveform | ~corresponds to cardiac cycle ~ 3 peaks ~2 descents |
CVP 'a' wave | ~from atrial contraction ~absent in afib ~exaggerated in juctional |
CVP 'c' wave | TV elevation during early ventric contraction |
CVP 'v' wave | venous return against closed TV |
CVP 'x' / 'y' descents | caused by downward displacement of ventrical during systole and TV opening during diastole |
CVP falsely elevated fluid volume | ~if RV fails to empty d/t PHTN or LVF ~high CVP incorrectly suggests fluid overload ~need PA |