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a.
b.
c.
d.
e.
The CVP is often used to make estimates of circulatory function, in particular cardiac function and blood volume
b.
The CVP does not measure blood volume directly and is influenced by right heart function, venous return, right
heart compliance, intrathoracic pressure and patient positioning
c.
Blood from systemic veins flows into the right atrium : the pressure in the right atrium is the central venous
pressure (CVP)
d.
e.
f.
1.
Rapid infusion
2.
3.
CVP is elevated by
a.
b.
c.
d.
b.
Vasodilatation
c.
myocard contractility
b.
c.
d.
Haemodialysis/plasmapheresis
e.
Rapid infusion
f.
e.
c.
femoral vein
d.
b.
c.
d.
e.
f.
Saline or heparinised saline to prime and flush the line after insertion
g.
h.
Sterile dressing
i.
Shaving equipment for the area if very hairy (especially the femoral)
j.
k.
Additional equipment required for CVP measurement includes: manometer tubing, a 3-way stopcock, sterile
saline, a fluid administration set, a spirit level and a scale graduated in centimeters
b.
Shave the needle insertion area prepare and check all the equipment for use
c.
Sterilise the skin and drape the area use the small local anaesthetic needte to locate the vein before using the
larger needle
d.
Potential complications
a.
Early
g.
Catheter embolus
a.
Arterial puncture
h.
Pneumothorax
b.
Bleeding
c.
Cardiac arrhythmias
a.
Venous thrombosis
d.
b.
e.
Injury to nerves
c.
Infection
f.
Air embolism
d.
Hydrothorax
b.
Late
b.
c.
Turn the tap to connect the patient, fluid level will drop to the level of the CVP (cmH2O)
d.
It will be slightly pulsatile and will continue to rise and fall slightly with breathing record the average reading
e.
In Intensive Care Units or theatres, electronic transducers may be connected which give a continuous readout
of CVP along with a display of the waveform
f.
The CVP reading from an electronic monitor is sometimes given in mmHg (same as blood pressure)
Low hypovolemia
- Give fluid challlenges until CVP rises and
c.
- Rapid pulse
pressure
doesnt
improve
consider
inotropes
b.
d.
Normal hypovolemia
- Rapid pulse
- Vasodilatation/constriction
f.
e.
- Rapid pulse
- Signs of infection
- Pyrexia
- Rapid pulse
The mean height of this coiumn (averaged over inspiration and expiration) represents the hydrostatic pressure
within the right atrium, the normal magnitude of which is 6 10 cmH2O
b.
Is commonly expressed as the vertical height (in cm) of this column of blood (the head) in relation to the sternal
angle (angle of Louis)
Measuring
a.
With the help of 2 rulers, this vertical height in relation to the sternal angle can be determined by the method of
triangulaton shown below
b.
the heat Of the jugular veanous pulse commonly seen at the level of the clavicle when he/she is reclining at an
angle of 45
c.
the hydrostatic pressure in the right atrium (in cm of H 2O) is equal to the vertical height (in cm) of the column cf
blood above the sternal angle plus 5 cm
b.
c.
d.
Hepatojugular reflux
a.
b.
By applying pressure to the epigastrium and indirectly to the liver, more venous return is pushed out of the liver
towards the heart
General technique
a.
b.
c.
Use the heel of your right hand to apply steasy pressure of the epigastric region of his abdomen for 15 20
seconds and note the JVP during this procedure
d.
Since breath-straining against a closed glottis can increase intra-thoracic pressure and JVP
e.