By Nicole Bayuntara

Head Nurse/ Technical Advisor

August 2012, Updated July 2013
 CVP = Central Venous Pressure
 CVP indicates Right Heart Function
 Is a direct measurement of the blood
pressure in the right atrium and vena
cava.
 CVP is an indicator of cardiac preload,
afterload and contractility. (How well the
heart is functioning)
 Indirectly reflects right ventricular end-
diastolic pressure.
 Volume of blood returning to the right
heart
 Vascular tone.
 Cardiac contractility.
 Patient position.
 Central venous access for CVP monitoring is obtained by
inserting a catheter into a vein, typically the subclavian or
jugular vein, and advancing it toward the heart until the
catheter tip rests within the superior vena cava near its
junction with the right atrium.
 Via a CVC.
 Connected with transducer, pressure bag, transducer cable
and Cardiac Monitor.
 Pressure Bag with IV Normal Saline up to 300mmHg
 Connect to Brown/Distal (Wider) Lumen of the CVC
 Pause IV fluids running into this lumen of CVC while zeroing
and taking CVP reading(No Inotropes should run through
this lumen with CVP)
 Zero Transducer (Off to patient, open to air, press zero on
monitor)
 Level with Phelbostatic Axis (Zero Point)
 3 to 8 cm H2O or 2 to 6 mm Hg.
 CVP is elevated by :
• overhydration which increases venous return
• heart failure or PA stenosis which limit venous
outflow and lead to venous congestion
• positive pressure breathing (Ventilation), straining,
 CVP decreases with:
• hypovolemic shock from hemorrhage, fluid shift,
dehydration
• negative pressure breathing which occurs when the
patient demonstrates retractions or mechanical
negative pressure which is sometimes used for high
spinal cord injuries.
 A smaller-than-usual waveform can be caused
by air bubbles in the system, thrombus
formation, lodging of the catheter against the
vessel wall, kinking of the catheter, incorrect
calibration, or a loose connection in the tubing or
transducer.
 An erratic waveform can result from movement
of the catheter tip within the vessel lumen (the
catheter may require repositioning).
 An absent waveform may indicate a large leak
in the system (usually noted by reflux of blood in
the tubing); a loose, cracked, or defective
transducer; air in the transducer; stopcock
turned to the wrong position; or thrombus
occlusion of the catheter tip.
The a wave is produced by RA systole (contraction) and
occurs 80 to 100 ms after the P wave on the ECG.
The c wave occurs with tricuspid valve closure; isovolemic
ventricular contraction forces the tricuspid valve to bulge
upward into the RA. The c wave follows the QRS on ECG.
The v wave occurs as the RA continues to fill during
against a closed tricuspid valve in late ventricular
systole. The v wave correlates with the peak of the T
wave on ECG.
The high point of the A wave is the atrial pressure at maximum
contraction and where to measure CVP.
The Z-point coincides with the middle to end of the QRS
wave. It occurs just before closure of the tricuspid valve.
Therefore, it is a good indicator of right ventricular end
diastolic pressure. The Z-point is useful when A waves are
not visible, as in atrial fibrillation.
 Perform hand hygiene.
 Place the patient in a supine position and explain the procedure to
patient. (If the patient can't tolerate being supine, make sure all
CVP readings are taken with the patient in the same alternate
position.)
 Locate the phlebostatic axis at the intersection of the mid-axillary
line and fourth intercostal space (see illustration).
 If an I.V. solution is being infused through the CVP monitoring line,
temporarily stop it and flush the line to prevent artifacts.
 Turn the three-way stopcock off to the patient and remove the cap
from the three-way port to open the system to air.
 Press the zero button on the monitor and look for a display
indicating the equipment has been zeroed.
 Replace the cap on the stopcock and turn the stopcock on to the
patient.
 Observe the CVP waveform and document the CVP reading and
patient position.
 Resume the I.V. infusion if indicated
 The CVP can also be measured manually using a
manometer.
 A 3-way tap is used to connect the manometer to
an intravenous drip set on one side, and, via
extension tubing filled with intravenous fluid, to
the patient on the other (Diagram 1). It is
important to ensure that there are no air bubbles
in the tubing, to avoid administering an air
embolus to the patient. You should also check
that the CVP catheter tubing is not kinked or
blocked, that intravenous fluid can easily be
flushed in and that blood can easily be aspirated
from the line.
 The 3-way tap is then turned so that it is open to the fluid
bag and the manometer but closed to the patient, allowing
the manometer column to fill with fluid (Diagram 2). It is
important not to overfill the manometer, so preventing the
cotton wool bung at the manometer tip from getting wet.
 Once the manometer has filled adequately the 3-way tap is
turned again – this time so it is open to the patient and the
manometer, but closed to the fluid bag (Diagram 3). The
fluid level within the manometer column will fall to the level
of the CVP, the value of which can be read on the manometer
scale which is marked in centimetres, therefore giving a
value for the CVP in centimetres of water (cmH2O). The fluid
level will continue to rise and fall slightly with respiration
and the average reading should be recorded.
 http://www.nursingcenter.com/prodev/c
e_article.asp?tid=1267859
 http://www.rnceus.com/hemo/cvp.htm
 http://www.anaesthesia.hku.hk/LearNet/
measure.htm