ASSISTING IN CVP INSERTION

(CVP Monitoring)

Central Venous Pressure Monitoring –

refers to the measurement of right atrial
pressure or the pressure of the great veins
within the thorax.
 Purposes:

• To serve as a guide for fluid

replacement.
• To monitor pressure in the right atrium
and control veins.
• To administer blood products, e.g.
Parenteral nutrition and drug therapy
contraindicated for peripheral infusion.
 Equipments:
• Venous pressure tray
• Cut down tray
• Infusion solution/infusion set with CVP
manometer
• Heparin flush system/pressure bag
• Arm board (for Antecubital insertion)
• Sterile dressing/adhesive tape
• Gowns, masks, caps and sterile gloves
• ECG monitoring
• Carpenter’s level (for establishing point)
 Vein site for catheter Placement

• Subclavian
• Internal or external jugular
• Median Basilic
 PROCEDURE:

• Define CVP monitoring and it’s purposes.

• Assemble equipments according to
manufacturer’s direction. (Evaluate
patient’s PT, PIT, CBC)
• Explain the procedure to the patient and
obtain informed consent.
• (Procedure is similar to an IV and the
patient may move in bed as desired after
passage of the catheter).
– Explain to patient how to
perform the Valsalva maneuver.
(The Valsalva maneuver
performed during catheter
insertion and removed,
decreased of air emboli).
– NPO
• Position patient approximately.
(Provides for maximum visibility of
veins)
– Placed in supine position
• Arm vein – extend arm and secure
and arm board
• Neck veins – place patient in
Trendelenburg position
• b. Placed small rolled towel under
shoulders
• ‘Trendelenburg position prevents
chance of air emboli. Anatomic access
and clinical status of patient are
considered in site delectation”.
• Flush IV infusion set and manometer
(measuring device) or prepare heparin
flush for use with a transducer.
• (Secure all connections to prevent air
embolic and bleeding).
• CVP site is surgically cleansed. Assist the
doctor to introduce the CVP catheter
percutaneously or by direct venous
cutdown. (Assist patient to remain
motionless during insertion).
• Monitor for dysarthymhias as a catheter is
threaded to a great vein or ® atrium.
• Connect primed IV tubing/heparin flush
system to the catheter. Allow IV solution to
flow at maximum rate to keep the vein open
(25 ml. Maximum).
• Attach manometer of IV pole. The zero
point of the manometer should be on the
level with the patient ® atrium.
• Place a sterile occlusive dressing over
sutured catheter site.
• Obtain a chest X-ray. (to verify correct
catheter position)
 How to Measure the CVP
• Place the patient in a position of
comfort
Rationale: A baseline position used for
subsequent readings.
• Position the zero point of the
manometer at the level of the right
atrium (supine position).
Rationale: The middle of the ® atrium is
the mid axillary’s line in the 4th
intercostals space
Right sided cardiac function is
assessed through the
evaluation of the central
venous pressure.
• Turn the stopcock so that the IV
solution in manometer flows into the
manometer. Filling to about 20-25 cm
level, then turn stopcock so that
solution in manometer flows into
patient
• Observe the fall in the height of the
column of fluid in manometer.
=To obtain venous access when
peripheral veins are
inadequate
= To insert temporary
pacemaker.
= To obtain central venous
blood samples.
• Record the level at which the solutions
stabilize or stop moving downward.
Record CVP and the position of the
patient.
• Rationale: CVP is not obstructed by clotted
blood if fluid in the manometer will
fluctuate slightly with the patients’
respiration, when there is open between the
catheter and manometer.
• Assess patient’s clinical condition to
detect whether the heart can handle its
fluid load
Rationale: CVP may range from 5-12 cm
of water or 2-6 mm/hg.
• Turn the stopcock drain to allow IV
solution to flow from solution bottle
into the patient’s vein.
• Observe from complication from
catheter insertion.
 Left sided heart function is less
accurately reflected by the
evaluation of control venous
pressure, but maybe useful in
assessing chronic right and left heart
failure and/or differentiating right
and left ventricular infarctions.
• Carry out nursing care in the
insertion site and maintain aseptic
technique.
• Send catheter tip for bacteriologic
culture when removed.
• Documentation. Label to show the
date and time of change plus the
name of patient
 ASSISTING CLIENT IN
ELECTROCARDIOGRAPHY
Assessment:
• Check the physician’s order
• Check the vital signs
• Know the purposes of the procedure
• Diagnosis to M.I., arteriosclerosis
cardiac arrhythmias, cardiac
enlargement, electrolyte imbalance
(K+Ca), pericarditis.
Procedure:
• Explain the procedure to patient – to gain
cooperation
• Screen, if necessary – to provide privacy.
• Position patient in a supine position with a
small pillow under his/her head.
• Provide grounds on the machine by using
steel bar of the bed.
• Apply the electrodes
• Stay, put on the motor, rotate the knob for
the lead.
• Put “off”, label the strip
• a). Name and age
• b). Date
• c). Physician no order
• Make the patient comfortable
• Do the after care.
• Check on the reaction of patient
and condition that need immediate
medical attention
• Documentation time , response of
the client, referral