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CVP Monitoring

ANP1 Exam 3

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
Created by: girlnamedsharon