PROCEDURE 70 • Knowledge of the normal anatomy and physiology of the cardiovascular system is needed. • Knowledge of the principles of aseptic technique and infection control is necessary. • Knowledge is needed of the principles of hemodynamic monitoring. • The central venous pressure (CVP)/right atrial pressure (RAP) represents right-sided heart preload or the volume of blood found in the right ventricle at the end of diastole. • CVP/RAP influences and is influenced by venous return and cardiac function. Although the CVP/RAP is used as a measure of changes in the right ventricle, the relationship is not linear. Because the right ventricle has the ability to expand and alter its compliance, changes in volume can occur with little change in pressure. • The CVP/RAP normally ranges from 2 to 8 mm Hg in the adult. • The central venous catheter is inserted in a central vein with the tip of the catheter placed in the proximal superior vena cava. • Knowledge is needed of the setup, leveling, and zeroing of the hemodynamic monitoring system (see Procedure 76). • Understanding of a, c, and v waves is necessary. The a wave reflects right atrial contraction. The c wave reflects closure of the tricuspid valve. The v wave reflects the right atrial filling during ventricular systole. The CVP/RAP measurement is the mean of the a wave. • CVP/RAP values are useful in evaluation of volume status, effect of medication therapy (especially medication that decreases preload), and cardiac function (Table 70-1). Table 70-1 Conditions Causing Increased CVP Elevated intravascular volume Depressed right-sided cardiac function (RV infarct, RV failure) Cardiac tamponade Constrictive pericarditis Pulmonary hypertension Chronic left ventricular failure Conditions Causing Decreased CVP Reduced intravascular volume* Decreased mean arterial pressure (MAP) Venodilation *Although the measured CVP is low, cardiac function may be depressed, normal, or hyperdynamic when there is reduced vascular volume. • Monitoring parameters from the femoral catheter is not recommended. The catheter is too distant from the right atrium to produce reliable data. • Pressure transducer system, including flush solution recommended according to institution standard, a pressure bag or device, pressure tubing with transducer, and flush device (see Procedure 76) • Pressure module and cable for interface with the monitor • Leveling device (low-intensity laser or carpenter level) Additional equipment to have available as needed includes the following: • Discuss the purpose of the central venous catheter and monitoring with both the patient and family. • Explain the patient’s expected participation during the procedure. • Determine hemodynamic, cardiovascular, and peripheral vascular status.
Central Venous/Right Atrial Pressure Monitoring
PREREQUISITE NURSING KNOWLEDGE
EQUIPMENT
PATIENT AND FAMILY EDUCATION
Rationale: This discussion reduces anxiety and includes the patient and family in the plan of care.
Rationale: The explanation encourages patient assistance.
PATIENT ASSESSMENT AND PREPARATION
Patient Assessment
Rationale: This assessment provides baseline data.Related posts:
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70: Central Venous/Right Atrial Pressure Monitoring
