CVP Monitoring usually has 20% of complication in total.
Haemorrhage - due to puncture.
Internal Jugular Cannulation - air embolism
Pneumothorax ; Hemothorax - punctured the pleural space.
Phlebitis - thrombus formation on tip or in vein.
Rx: continuous infusion of unfrac. heparin may reduce the risk.
Bacterial Colonisation - cellulitis & sepsis.
Central venous pressure is considered a direct measurement of the blood pressure in the right atrium and vena cava. It is acquired by threading a central venous catheter (subclavian double lumen central line shown) into any of several large veins. It is threaded so that the tip of the catheter rests in the lower third of the superior vena cava. The pressure monitoring assembly is attached to the distal port of a multilumen central vein catheter.
Check List :
Adhere to institutional Policy and Procedure.
Obtain history and assess the patient.
Explain the procedure to the patient, include:
local anesthetic - 1-2% lidocaine 5-10ml SC.
trendelenberg positioning
draping
limit movement after insertion
need to maintain sterile field
post proceduce CXR
Obtain a sterile, flushed and pressurized transducer assembly
Obtain the catheter size, style and length ordered.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status.
Normal CVP is 2-6 mm Hg / 2-8cmH20
CVP is elevated by :
overhydration which increases venous return
heart failure or PA stenosis which limit venous outflow and lead to venous congestion
positive pressure breathing, straining,
CVP decreases with:
hypovolemic shock from hemorrhage, fluid shift, dehydration
negative pressure breathing which occurs when the patient demonstrates retractions or mechanical negative pressure which is sometimes used for high spinal cord injuries. 
Find the mean of the A wave.
read the highest point of the A wave and take the lowest point of the A wave
add the high point to the low point
divide the sum by 2
the result is the mean CVP
The A wave starts just after the P wave ends and represents the atrial contraction. The high point of the A wave is the atrial pressure at maximum contraction. During the A wave the atrial pressure is greater than the ventricular diastolic pressure. At that point, the atrium is contracted, the tricuspid is open. Therefore, the high point of the A wave closely parallels the right ventricular end diastolic pressure. Remember, when the tricuspid valve is open and the right ventricle is full, the ventricle, atrium and vena cavae are all connected. Therefore, that point is the CVP.
2. Find the Z-point.
Find the Z-point which occurs mid to end QRS
Read the Z-point
The Z-point coincides with the middle to end of the QRS wave. It occurs just before closure of the tricuspid valve. Therefore, it is a good indicator of right ventricular end diastolic pressure. The Z-point is useful when A waves are not visible, as in atrial fibrillation. (The c-wave occurs at closure of the tricuspid valve. The crest of the c-wave is the atrial pressure increase caused by the tricuspid valve bulging back into the atrium.)
Doe :P
