Where is CVP located? And what’s its normal value according to the lecture?
in the vena cava at the junction with the right atrium. It’s normal value is 10 (8~12)mmHg
The CVP reflects ___(left/right?) heart function and is not a reliable indicator of ___(left/right?) ventricular performance.
If ____decreases, the CVP decreases.
right side preload
Know where all the waves and descents are on the graph
What are some common insertion sites for central line
Internal jugular: left or right; Sublcavian; Femoral; Brachial
What’s the proper way to prep for CVP with cholrhexidine?
Use back and force motion for 30sec for dry area and 2min for moist area
What are some factors that can affect CVP?
cardiac performance, blood volume, vascular tone, increased intra-abdominal or intrathoracic pressures and vasopressor therapy
What does A wave indicate and where does it correspond to EKG?
atrial contraction; Occurs right after P wave on the ECG
What would cause A wave to increase?
Tricuspid Stenosis; RVH; Pulmonary Stenosis; Pulmonary Hypertension; Giant A Waves-Cannon: AV block-RA contracts against a closed tricuspid valve
What does C wave indicate and where does it correspond to EKG?
Caused by elevation of tricuspid valve into the right atrium during early ventricular/systolic contraction; Corresponds to the end of the QRS on the ECG
What does X descent indicate and where does it correspond to EKG?
The X descent results from an atrial relaxation and downward displacement of the tricuspid valve during ventricular systole. Occurs during ST segment on the EKG
When would X descent disappear?
in tricuspid regurgitation
What does V wave indicate and where does it correspond to EKG
Caused by pressure produced when the blood filling the right atrium hits against a closed tricuspid valve; Corresponds to the end of the T wave on the ECG
What happens to V wave in Tricuspid Regurgitation?
Prominent V waves
What does Y descent indicate and where does it correspond to EKG
Produced by blood flowing into the right ventricle through an open tricuspid valve; Occurs before the P wave (prior to atrial contraction) on the ECG
Indications for CVP?
To monitor pre-load; Hypovolemia ; Shock; Aspiration of Air Emboli; TPN; Insertion of transcutaneous pacing leads; IV access in patients with poor peripheral veins; Infusion of vasoactive medications
Contraindications for CVP?
Tumors in the right atrium; Severe Coagulopathy; Ipsilateral carotid endarterectomy
Complications can be caused by central line placement
Pneumothorax; Carotid Artery Puncture; Hemothorax from Vascular rupture; Air Embolism, wire embolization, thrombosis; Cardiac Perforation; Hematoma; Cardiac Tamponade; Arrhytmias, Hydrothorax, Chylothorax; Infection