NURSING RESPONSIBILITIES

Normal

values are 2-6 mmHg or 5-10cm

H2O ELEVATED READINGS: hypervolemia (increased circulating blood volume) or by a condition, such as HF, that results in a decrease in myocardial contractility. DECREASED READINGS: hypovolemia (decreased circulating blood volume or reduced right ventricular preload)

PRE-INSERTION
Obtain a signed consent for insertion. Shave the site for insertion (if necessary) and cleanse with an antiseptic

solution.

POST-INSERTION
The patient must be positioned comfortably on bed either on a supine or a

backrest position up to a 45 degree angle. Determine the phlebostatic axis. The phlebostatic axis is the crossing of two reference lines: (1) a line from the fourth intercostal space at the point where it joins the sternum, drawn out to the side of the body beneath the axilla; and (2) a line midway between the anterior and posterior surfaces of the chest. After locating this position, make an ink mark on the patients chest to indicate the location.

 MANOMETER:
Line up the manometer arm with the phlebostatic axis ensuring that the bubble is between the two lines of the calibration.
Zero the Manometer: Move the manometer scale up and down to allow the bubble to be aligned with zero on the scale.

Turn the three-way tap off to the patient and open the line of the manometer.

 Prime the manometer to a level higher than the expected CVP (up to 20 cm) The fluid level inside the manometer should fall until gravity equals the pressure in the central veins. When the fluid stops falling the CVP measurement can be read. If the fluid moves with the patient's breathing, read the measurement from the lower number. Turn the tap off from the line of the manometer.

 TRANSDUCER:
Attach the CVC to an intravenous fluid within a pressure bag which should be inflated up to 300 mmHg. Tape the transducer to the phlebostatic axis or as near to the right atrium as possible.
Turn the tap off to the patients line and open to the air. Remove the cap from the three-way port and open the system to the atmosphere.

 Press the zero button on the monitor and wait while the calibration appears. When zeroed, replace the cap on the three-way tap and turn the tap on to the patients line. Observe the CVP trace on the monitor. The waveform, may undulate as the right atrium contracts and relaxes, emptying and filling with blood.

 Document the level or reading as ordered.

Maintain the reading within the normal range.

Avoid letting the patient strain or lessen the stress on the patient when performing procedures.
Ensure that the CVP catheter inserted has a dressing that is dry, sterile and air

occlusive.
Monitor distal extremity for color, sensation, swelling and movement q 1 h.

Document any finding not within normal limits. All stopcocks must have dead-end (non-vented) luer lock caps or luer lock connected infusions. This includes stopcocks located on transducers.
Inspect the site daily for signs of infection, air embolism, catheter occlusion and

arrhythmias (displaced catheter).

Flush the tubings regularly with normal saline solution.