Questions and Answers
What is the primary use of central venous pressure monitoring?
What is a contraindication for central venous catheterization?
What is the normal range for central venous oxygen saturation?
What is the primary complication of central venous catheterization?
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What is the purpose of floating a Swan?
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What is the indication for using a central venous catheter in patients with poor peripheral veins?
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What is the significance of a low central venous oxygen saturation?
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What is an elevated central venous oxygen saturation indicative of?
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What is the recommended angle to the skin when advancing the needle during internal jugular vein cannulation?
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Why is it recommended to use bactericidal skin prep with alcohol-based solutions during internal jugular vein cannulation?
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What is the purpose of aspirating continuously while advancing the needle during internal jugular vein cannulation?
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What is the recommended method to confirm venous vs arterial pressure during internal jugular vein cannulation?
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What is the purpose of flushing each of the ports to remove air during internal jugular vein cannulation?
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What is the recommended landmark to locate the internal jugular vein during cannulation?
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What is the purpose of using sterile gloves, gown, mask, and hair cover during internal jugular vein cannulation?
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Why is real-time ultrasound guidance recommended during internal jugular vein cannulation?
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What is the primary purpose of leaving the most distal port open during catheter placement?
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What is a potential complication of central venous cannulation?
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What is the approximate right atrial pressure reflected by central venous pressure (CVP)?
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What is the purpose of placing a finger or thumb over the connection point on the catheter during guidewire removal?
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What is a characteristic of non-compliant ventricles?
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What is the typical range of normal CVP values in cm H2O?
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What is the purpose of securing the connection of the appropriate monitoring tubing or infusion tubing?
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What is the significance of the 'a' wave in the CVP waveform?
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Study Notes
Central Venous Catheterization
- Indications: Monitoring central venous pressure (CVP), fluid administration to treat hypovolemia and shock, infusion of caustic drugs and total parenteral nutrition (TPN), aspiration of air emboli, insertion of transcutaneous pacing leads, and gaining venous access in patients with poor peripheral veins
- Contraindications: Tumors, clots, or tricuspid valve vegetations that could be dislodged or embolized during cannulation, and site-specific contraindications
Technique of Central Venous Catheterization
- Prepare the site with hand scrub, sterile gloves, gown, mask, hair cover, bactericidal skin prep, and sterile drapes
- Locate the internal jugular vein using landmarks or real-time ultrasound guidance
- Advance a needle along the medial border of the lateral head of the sternocleidomastoid toward the ipsilateral nipple, and an angle of 30o to the skin while pointing just lateral to the carotid artery pulse
- Aspirate continuously to obtain venous blood and confirm the needle's location in a vein
- Use a secondary needle or a syringe with needle to advance the guide wire through the syringe without the need for both a locator needle and placement needle
- Transduce free blood flow to confirm venous vs arterial pressure using IV extension tubing or tubing included in the access kit
- Prepare the catheter for placement by flushing each of the ports to remove air using saline or LR
Risks of Cannulation
- Line infection
- Bloodstream infection
- Air or thrombus embolism
- Arrhythmias indicating the catheter tip is in the right atrium or ventricle
- Hematoma
- Pneumothorax
- Hemothorax
- Hydrothorax
- Chylothorax
- Cardiac perforation
- Cardiac tamponade
- Trauma to nearby nerves and arteries
- Thrombosis
Clinical Considerations of Central Venous Pressure (CVP)
- CVP approximates right atrial pressure
- Ventricular volumes are related to pressures through compliance, with highly compliant ventricles able to accommodate volume with minimal changes in pressure
- Noncompliant ventricles have larger swings in pressure with less volume change
- A very low CVP may indicate a volume-depleted patient, but moderate to high pressure readings may reflect volume overload, poor ventricular compliance, or both
- Using CVP in conjunction with other measures of hemodynamic performance may be a better indicator of a patient's volume responsiveness
CVP Waveform
- The shape of the waveform corresponds to the events of cardiac contraction
- The waveform consists of five different waves:
- a waves are from atrial contraction
- Other waves will be described individually
Pulmonary Artery Catheterization
- Introduce pulmonary artery (PA) catheters and discuss risks and benefits of their use
- Discuss pulmonary artery catheter placement, and how to "Float a Swan"
Cardiac Output Measurements
- Introduce and discuss various techniques for monitoring and calculating cardiac output
- Discuss echocardiography and the TEE probe with common views
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Description
Learn about central venous pressure, pulmonary artery pressure, and cardiac output measurements, including risks and benefits of cannulization and catheter placement.
