Measurement of CENTRAL
VENOUS PRESSURE via a
Transducer
PRESENTED BY:
C. SAM ILA KYNDIAH
M S C ( N ) 1 ST Y E A R
NINE, PGIMER
Key terms
1. Central venous pressure
2. Central venous pressure monitoring
3. Phlebostatic axis
Introduction
CVP is considered equivalent to right atrial pressure
It is used to estimate a patient’s cardiac function,
venous return to the heart, and gauge how well the right
ventricle of the heart function, if the heart cannot
accept blood, then it will back up into the venous
system affecting the intravascular fluid volume status.
How does a CVP works?
Because no major valves lie at
the cavo-atrial junction,
pressures during systole and
diastole reflect back to the
catheter allowing for CVP
measurement. Normal CVP
values range 2-6mmHg
or 4-12cmH20
Wheatstone principle of Transducer
Superman take care of this!
What does CVP values mean?
increase decrease
Fluid overload
Right heart failure Shock
Cardiac tamponade Hypovolemia
Pleural effusion Forced inhalation
Tension pneumothorax
Forced exhalation
Mechanical ventilation
Equipments needed
Transducer
Transducer cable
Transducer holder
Pressure bag
Disposable pressure tubing
Yard stick
Hepsaline
Ensuring accuracy
1. Priming of the pressure tubing
2. Levelling and zeroing
3. Dynamic response testing
Priming the pressure tubing
Use 500 mL Hep Saline
Use aseptic technique to spike bag , prime entire tubing
(stopcocks, luer-locks, transducer)
Eliminate all air bubbles as they can be a main factor in
waveform blunting or overdamping
Insert IV fluid bag into pressure bag and inflate the
pressure bag to 300 mmHg
Label IV bag with date and time solution is hung +
initials
Priming the tubing cont.....
• Check all connectors on tubing as they may be loose.
Make sure that the connectors are secure but don’t
over tighten them b/c they can become stripped
Insert IV fluid bag into pressure bag and inflate the
pressure bag to 300 mmHg. Why?
Prevents air from going into the solution and catheter
from clotting, allows 3ml/hr flush solution to be
delivered through the catheter
Priming the tubing cont.....
Insert transducer into the transducer holder that
mounts onto the IV pole
Avoid over tightening and stripping of connectors
Prime entire tubing system including stopcock, luer-
locks, and transducer
Priming the tubing cont....
Clamp CVC lumen to be used
Scrub CVC port with alcohol swab (15 sec)
Connect transducer directly to CVC port
When is ZEROING needed?
Whenever the air-fluid interface and whenever the
reference point changes. Position change, when
accuracy of waveform reading is questionable
Zeroing the transducer
Place HOB from zero to 45 degrees. Supine is
recommended
Position the patient and the transducer at the same
level - Make sure the transducer is located at the
phlebostatic axis
With a carpenter’s level or yard stick locate the
phlebostatic axis (right atrium of the heart – 4th
intercostal space, midaxillary line). This ensures the
accuracy of the readings by eliminating hydrostatic
forces on the transducer.
If transducer is too high will have falsely low BP readings.
If the transducer is too low will have falsely elevated BP
readings.
Location of the phlebostatic axis
Phlebostatic axis
Zeroing the transducer
Turn the stopcock just above the transducer off to the
patient’s arterial catheter … “off to the patient”
Zero Balance & Calibrate the Transducer by:
Open stopcock on transducer to port or “air”
Remove dead-end cap
Activate flush device
Press zero button on bedside monitor (will read 0)
Return stopcock back to port/monitoring position
Replace dead-end cap
Maintaining a CVP line
Assess flush system every 4 hours to ensure pressure
bag is inflated to 300mmHg and that fluid is present in
flush solution
Evaluate pressure monitoring system regularly for air
bubble formation and remove if present
Evaluate the patient regularly for signs or symptoms of
catheter-related infection
Precautions & key points
Monitor alarms set at appropriate limits
Obtain baseline data including vital signs, level of
consciousness, and hemodynamic stability to help
identify acute changes in the patient.
Ensure that pt is still while CVP reading is being
taken – measure at end expiration
If CVP fluctuates by more than 2mmHg suspect
change in clinical status and report
Precautions and key points cont ...
Ensure that the patient is still while the CVP reading
is being taken to prevent artifacts.
Transparent dressings should be changed every 7
days and SOS
Assess catheter necessity daily
Complications of CVP monitoring include sepsis,
thrombus, vessel puncture, and air embolism
Documentation
Position for zeroing the transducer
CVP readings, interventions, outcomes, and if MD
was notified
Dressing, tubing, flush solution changes, and
discontinuation of line
References
Lippincott Williams & Wilkins (2011). Lippincott’s Nursing
Procedure and Skills. Central venous pressure monitoring,
transducer. Retrieved July 24, 2011 from,
http://procedures.lww.com/lnp/view.do?searchQuery=Arterial%20
pressure%20monitoring&pId=912702
Lippincott Williams & Wilkins (2011). Lippincott’s Nursing
Procedure and Skills. Transducer system setup. Retrieved June 30,
2011 from,
http://procedures.lww.com/lnp/view.do?searchQuery=Transducer
%20system%20setup&pId=164403
Pittman, J. A.L., Ping, J.S., Mark, J.B (2006). Arterial and central
venous pressure monitoring. Anesthesiology Clin, 24(4), 717-35.
Rauen, C.A., Makic,m.B., & Bridges, E. (2009). Evidence-based
practice habits: Transforming research into bedside practice.
Critical Care Nurse 29(2), 46-59
