Cvp central venous pressure monitoring
- 1. Central Venous Pressure Monitoring 犖犖迦犖犖迦硯犖犖巌権犖犖園犖犢 犖о犖犢犖犖犖迦権犢犖犖 犖犖∇顕犖犖迦献犖о鹸犖犖迦犖朽 犖犖犖巌犖犖巌犖迦犖犖朽 ICU trauma 犖
- 2. 犖犢犖 犖犢犖 犖犖朽犢 犖犖犖迦牽 monitor CVP 犖÷元 犖犖園 犖犖朽 1.油 犢犖犖犖項犢犖о権犖犖朽犖犖犢犖犖朽権犢犖ム厳犖犖犖犖迦犖犖伍犖犖巌犖犖犖伍見犖犖劇賢 犢 犖 犖 犖犖迦犖犖迦牽犖犢犖迦犖園 犖犖迦硯犖 sepsis 犢犖ム鍵犖犖犖犖朽賢犖劇犖犖犖朽犖犖橿顕 犢犖犢犖犖犖巌検犖迦犢犖ム厳犖犖犢犖ム鍵犖犖橿犖迦犖犖犢犖迦犖犖迦権犖ム犖ム 2.油 犢犖犖犖項犢犖о権犖犖朽犖÷元犖犖迦硯犖萎犖橿犖迦犖犖巌 犢 3.油 犢犖犖犖犖犖朽犖朽犖犢犖犖犖犖迦牽犖犖犖萎犖÷鹸犖犖犖迦牽犖犖橿顕犖犖迦犖犖犖 犖犖園硯犢犖犢犖ム鍵犖犖ム賢犖犢犖ム厳犖犖
- 3. Central Venous Pressure (CVP) 犖犖÷顕犖∇犖謹 犖犖о顕犖÷犖園犢犖犖犖ム賢犖犢犖ム厳犖犖犖犖橿顕 Superior Vena Cava (SVC) 犖犖謹犖犖÷元犖犢犖迦犖犢犖迦犖園犖犖о顕犖÷犖園犖犖犖 right atrium (RA) 犢犖ム鍵犢犖犢犖犖犖迦牽犢犖犖犖犖犖謹 preload 犖犖犖 right ventricle (RV) 犖犖犖劇賢 right ventricular end-diastolic pressure (RVEDP) 犖犢犖 CVP 犖犖萎犖犖犢犖犢犖犖謹犖犖犖巌検犖迦犖犖橿犖迦犖ム鍵犢犖ム厳犖犖犖犖朽犢犖犖ム犖о元犖∇ 犢犖犖犢犖迦犖犖迦権 犖犖犖萎肩犖巌犖犖巌犖迦犖犖犖 right ventricle 犢犖ム鍵 venous capacitance 犖犖犖巌検犖迦犖犖橿犖迦見犖犖劇賢犢犖ム厳犖犖犢犖犖犖園硯犢犖 犖犖朽犖犢犖迦権 (Left Atrial Pressure, LAP) 犖犖迦犖о険犖犢犖犖∇犖迦牽犢犖犢 犖犖迦権 polyvinyl catheter 犢犖犢犖迦犖犢犖 left atrium 犢犖犖∇犖犖犖犖萎見犖о犖迦犖犖迦牽犖犢犖迦犖園犖犖園硯犢犖犢犖犖犢犖犖巌 犖犖犖劇賢犢犖犖∇犖犢 Swan-Ganz catheter 犖犢犖迦犖犖迦犢犖犢犖犢犖ム厳犖犖犖犖橿顕犢犖犖犢犢犖犢犖迦肩犖項 pulmonary artery 犢犖ム鍵犖о険犖 Pulmonary Capillary
- 4. 犖о鹸犖 犖 犖迦牽犖о険犖 CVP 犖 1.犖犖犖犢犖犢犖犖項犖犢犖о権犖犖犖迦犢犖ム鍵犖ム犖迦犖÷厳犖犢犖犢犖犖萎賢犖迦 2. 犖犖園犖犢犖迦犖項犖犢犖о権犢犖犢犖犖犖犖犖犖迦権犖犖迦 (犖犖項犖犢犖о権犖犖迦犖犖迦権犖÷元犖犢犖 犖犖橿顕犖犖園犢犖犖犖迦牽犖犖犖犖犖迦犖犖犖劇賢犖犖迦 犖犖犖犢犖犖犖劇犖犖∇犖犖萎犖朽犖犖犖犖犖迦 犖犖園犖犢犖迦絹犖朽牽犖犖萎肩犖項犢犖犢犢犖÷犢犖犖巌 45 犖犖犖犖) 犢犖ム鍵犢犖犖犖犖迦犖犖萎犖朽硯犖園 犢 犖犖о牽犢犖犖∇元犖∇犖犖犖 3. 犖犖迦犖橿顕犢犖犖犢犖犖犖犖 zero 犖犖犖劇賢 phlebostatic axis 犖犖劇賢 犖犖伍犖犖園犖犖犖 midaxillary line 犖犖園 fourth intercostal space
- 5. 犖о鹸犖 犖 犖迦牽犖о険犖 CVP 犖
- 6. 犖о鹸犖 犖朽 犖迦牽犖о険犖 CVP 犖犖迦牽犖犢犖迦犖犢犖 CVP 犖犖朽 work 犖犖 犖犖萎犢犖犖 fluctuate 犖犖犖劇賢犖÷元犖犖迦牽犢犖犢犖犖犖謹犖犖ム犖犖犖犖犖萎犖園犖犖橿犖迦犖 犖犖迦権犖犖朽犢犖÷犖犖犖犖犖園犖犖迦検犖犖園犖犖о鍵犖犖迦牽犖犖迦権犢犖 (犖犖迦犖犖犖о犖 犢犖犢犖 犖犖謹犖 犖ム犖犖迦検犖犖朽 犖犖 犢犖犖犖犖о犖 犖犖ム顕犖∇肩犖迦権 CVP 犖犖∇弦犢犖 犖謹 犢犖犖巌 犢犖犖ム犢犖犢犖 犢犖犖犖謹 犢犖犖犖園硯 犢犖) 犢犖犢犖犢犖迦犖犢犖迦犖÷厳犢犖犢犖犖巌犖÷犖犖犖朽 犢犖犖∇賢犢犖迦犖犢犖迦犢犖о犖犖迦権犢犖 犖犖犖犖犖伍 (end of expiration) 犢犖犖劇犖犖犖犖迦犖犖о顕犖 犖犖園犢犖犖犢犖犖犖犖犖о犖犖犖犖萎犖犖ム犢犖犖朽権犖犖犖園犖犖о顕犖÷犖園 犖犖犖犖∇顕犖犖迦絹
- 7. 犖犖迦牽犢犖犖ム犢犖 CVP 犖犢犖 CVP 犖犖犖犖 犖犖迦犖犖∇弦犢犢犖犖犢犖о 6-12 cmH2O 犖犖園犖犖朽犖÷ 犢 犖 犢犖犢犖犢犖 CVP 犢犖犖犖迦牽犢犖犖犖朽権犖犢犖犖朽権犖犖犖迦牽犢犖犖ム元犢犖∇犢犖犖ム犖犖迦 犖犖迦牽犖犖園犖犖迦犖犖犖項犖犢犖о権犖犖迦権犖犖園犢 犖÷顕犖犖犖о犖 犢 犖犢犖 CVP 犖犖橿犖 犖犖÷顕犖∇犖謹 犖犖犖巌検犖迦犖犖橿犖迦犖ム鍵犢犖ム厳犖犖犢犖犖犢犖迦犖犖迦権 犖ム犖ム 犖犢犖 CVP 犖犖項犖犖謹犖犖÷険犖 犖犖÷顕犖∇犖謹犖犖犖巌検犖迦犖犖橿犖迦犖ム鍵犢犖ム厳犖犖犢犖 犖犢犖迦犖犖迦権犖÷顕犖犖犖謹犖 犖犖朽肩犖橿顕犖犖園犢犖犖犖迦牽犢犖犖ム犢犖 CVP 犖犖萎犢犖犖犖犖 犢 犖犖迦犖迦牽犢犖ム鍵犖犖迦犖迦牽犢犖犖犖犖犖劇犖犖犢犖о検犖犢犖о権 犢犖犢犖 blood pressure, heart rate, urine output, urine specific gravity, intake/output, conscious, 犖犖園犖犖犖犢犖犢犖∇鹸犖犢犖犖朽権犖犖犖巌犖犖犖犖 犖犖迦犖迦牽犖犖犖犢犖犖犖劇犖犖 犖犖о顕犖 犖犖謹犖犖園硯 犖犖о顕犖÷賢犖伍犖 犢犖∇犖 犖犖劇犖犖犖犖犖犖巌硯犖犖犖園 犢犖犢犖犖犢犖
- 8. 犖犢犖 CVP 犖犖項 犢犖ム鍵犖犖橿犖 犖犖犢犖犢犢 犖犖犖ム顕犖∇ 犖犖迦犖犖犖 犖犖園 犖犖朽 犖犖迦犖犖犖伍 犖 犖橿顕 犢犖犢 犖朽 CVP 犖犖項 Elevated vascular volume Increased cardiac output (hyperdynamic cardiac function) Depressed cardiac function (RV infarct, RV failure) Cardiac tamponade Constrictive pericarditis Pulmonary hypertension Chronic left ventricular failure
- 9. 犖犖迦犖犖犖伍 犖朽犖 犖橿顕 犢犖犢 CVP 犖犖橿犖 Reduced vascular volume Decreased mean systemic pressure (e.g., as in late shock state) Venodilation (drug induced)
- 10. Fluid Challenge Test Initial CVP <8 8-15 >15 cm H2O PAOP <12 12-16 >16 mm Hg Volume & Rate 200 mL/10 min 100 mL/10 min 50 mL/10 min During infusion, CVP rises >5 cm H2O or PAOP rises >7 mm Hg Yes No Stop challenge Complete the volume Wait 10 min Wait 10 min CVP change >5 3-5 <2 3-5 <2 PAOP change >7 4-7 <3 4-7 <3 10
- 11. Central Venous Pressure Monitoring 犖犖園犖 犖犢犖 犖犖伍 犖犖犖犢 犖犢犖 set iv 犢犖犢犖迦犖園 犖犖о犖犖橿犖迦犖犖ム厳犖 0.9 NSS 100 ml. 犢犖ム犖 犖犢犖犖犖迦権 IV 犢犖犢犖迦犖園犖犖園硯 transducer 犢犖ム犖о犢犖犖犖迦権 extension 犢犖犢犖迦犖園 transducer 犖犢犖犢犖犢犖 犖犖橿顕犖犖犖園犖о顕犖transducerg 犢犖犢犖迦犖園犢犖犖迦犖橿犖迦犖犖ム厳犖 犢犖犖∇犖園硯 犢犖犢犖犖犢犖犖犖犖∇弦犢犢犖犖犖橿顕犢犖犖犢犖 phlebostatic axis 犖犖劇賢 midaxillary line 犖犖園 fourth intercostal space
- 12. Central Venous Pressure Monitoring 犖犖迦犖犖園犖犢犖犖巌犖犖橿犖迦犖犖ム厳犖 犢犖犖劇犖犢犖ム air 犖犖朽犖犖∇弦犢犢犖 set 犖犖園犖犖犖÷ 犢犖犖犢犖 犢犖ム犖о犢犖犖犖迦権 extension 犢犖犢犖迦犖園 犖犖迦権 cutdown 犖犖犖劇賢 subclavian vein 犢犖犖 subclavian 犖犢犖犢犖犢犖迦犖園犖犖迦権 犖犖 犖犖橿犖迦犖迦献 犖犖犖劇賢 proximal lumen
- 13. Central Venous Pressure Monitoring 犖犢犖monitor 犖犢犖 犖犖迦権 cable 犢犖犢犖迦犖朽 犖犖monitor
- 14. Central Venous Pressure Monitoring 犢犖ム厳犖犖犖犖犖巌 cable 犖犖朽犢犖 犢 犢犖犢犖迦犖 犢犖犢犖 CVP 犢犖犖 犢犖ム厳犖犖 犖犖朽 label 犢犖ム厳犖犖 CVP
- 15. Central Venous Pressure Monitoring 犖犖 zero cal 犖犖犢犖犖犖劇犖犖 calibrate 犢犖犢 cvp = 0 mmHg 犢犖犖犢犖犢犖ム犖о犢犖犖÷幻犖 three way 犖÷顕犖犢犖迦犖犖伍 three way 犖犖迦検犢犖犖巌検犢犖ム鍵犖犖巌犖犖伍
- 16. 犖犖迦牽犖犢犖 犖犖犢犖 CVP wave
- 17. Normal CVP Waveform systole diastole a c v x x y 17
- 18. 犖犖迦牽犖犢犖 犖犖犢犖 CVP wave A wave - due to atrial contraction. Absent in atrial fibrillation. Enlarged in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension. 油C wave - due to bulging of tricuspid valve into the right atrium or possibly transmitted pulsations from the carotid artery. X descent - due to atrial relaxation. 油V wave - due to the rise in atrial pressure before the tricuspid valve opens. Enlarged in tricuspid regurgitation
- 19. CVP Waveform Three Peaks (a, c, v) Two Descents (x, y)
- 20. a wave Caused by atrial contraction (follows the P- wave on EKG) End diastole Corresponds with atrial kick which causes filling of the right
- 21. c wave Atrial pressure decreases after the a wave as a result of atrial relaxation The c wave is due to isovolemic right ventricular contraction; closes the tricuspid valve and causes it to
- 22. x descent Atrial pressure continues to decline due to atrial relaxation and changes in geometry caused by ventricular contraction Mid-systolic event Systolic collapse in atrial pressure
- 23. v wave The last atrial pressure increase is caused by filling of the atrium with blood from the vena cava Occurs in late systole with the tricuspid still closed
- 24. y descent Decrease in atrial pressure as the tricuspid opens and blood flows from atrium to ventricle Diastolic collapse in atrial pressure
- 25. Tricuspid Regurgitation The right atrium gains volume during systole - so the c and v wave is much higher The right atrium sees right ventricular pressures and the pressure
- 26. Tricuspid Stenosis Problem with atrial emptying and a barrier to ventricular filling on the right side of the heart Mean CVP is elevated a wave is usually prominent as it tries to overcome the barrier to emptying y descent muted as a result of decreased outflow from atrium to ventricle
- 27. Pericardial Constriction Limited venous return to heart, elevated CVP, end-diastolic pressure equalization in all cardiac chambers Prominent a and v waves, steep x and y descents Characteristic M
- 28. Cardiac Tamponade Changes in atrial and ventricular volumes are coupled, so total cardiac volume does not change when blood goes from atrium to ventricle CVP becomes monophasic with a single, prominent x descent with a muted y descent Similar to pericardial constriction but not exactly the same
- 29. 犖犖迦硯犖萎犖犖犖犖犢犖 犖犖犖園犖 犖犖迦犖犖園犖 犖犖犖犖犖迦牽犢犖犢犖 犖迦権 CVP 犢犖ム鍵犖犖迦牽犖о険犖 犖÷元犖 犖園 犖犖朽 1.油 Hemothorax 2.油 Pneumothorax 3.油 Nerve injury 4.油 Arterial puncture 5.油 Thoracic duct perforation 6.油 Arrhythmias 7.油 Systemic or local infection 8.油 Perforation or erosion of vascular structure 9.油 Thrombosis 10.油油Air embolism 11.油油Blood loss 犖犖迦犖犢犖 犖犢犖 犖犖ム幻犖 12.油油Volume overload 犖犖迦犖ム厳犖 犖犖犖園 rate IV 犖犖ム険犖 犖о険犖 CVP油油
- 30. 犖犖犖犖犖伍 犖犢犖
Editor's Notes
- #6: 犖犖÷幻犖 three-way 犢犖犢 IV fluid 犢犖犖ム犖犢犖迦犖犢犖犖犖迦権 iv 犖犢犖迦犢犖÷犖犖犖犖犖園 犢犖犖∇犖巌犖犢犖迦犖犖項犖犢犖о権犢犖о犖犢犖犖 犖犖о牽犢犖犢 IV fluid 犖犖∇弦犢犢犖犖犖迦権 犢犖犖犖萎犖園犢犖犖劇賢犖犢犖犢犖÷肩犖迦権 犖犖犖劇賢犖÷顕犖犖犖о犖迦犢犖迦犖犖巌検 ( 犖犖犖萎検犖迦 5 cm) 犖犖迦犖犖園犖犖犖÷幻犖犖犖巌 three-way 犖犢犖迦犢犖÷犖犖犖犖犖園 5. 犖犖橿犖÷犖犖犖犖犖園犖о顕犖犖犖迦犖犖朽犖犖項犖犢犖о権 犢犖犖∇犖犢犖犖橿犖犖犢犖犖犖犖 zero 犖犖犖劇賢犢犖ム犖犖項犖∇ 犖犖謹犖犖犖伍犖犖朽犖о顕犖犖犢犖犖犖犖∇弦犢犖犖萎犖園犢犖犖朽権犖о犖園 right atrium 犖犖園犖犖犖劇賢犖犖朽犖犖橿犖犖犢犖犖犖伍犖犖園犖犖犖 midaxillary line 犖犖園 fourth intercostal space 6. 犖犖÷幻犖 three-way 犢犖犖巌犢犖犖犖迦鍵犖犢犖迦犖犖項犖犢犖о権犖犖園犢犖÷犖犖犖犖犖園 犖犖巌犖犢犖迦 IV ( 犖犖犖犖朽犖朽犖÷元 three-way 犖犖ム顕犖∇賢犖園 犢犖犢犖犖犖園犢犖犖犖迦鍵犖犖園犖犖朽犖犖∇弦犢犖犖巌犖犖園犖犖迦権 cut down 犖犖犖劇賢犖犖園犖犖朽犖÷元犢犖÷犖犖犖犖犖園 )
- #11: 犖犢犖迦犖項犖犢犖о権犖÷元犖犢犖 CVP 犖犖項犢犖犢犖÷元犖犖迦犖迦牽 犢犖÷犖犖犖犖犖ム犖犖犖犖園犖犢犖 CVP 犖犖劇賢 HR 犢犖犢犖 犖犖謹犖犖犢犖 CVP 犖犖朽犖犖項犖犖迦犢犖犖巌犖犖迦犖犖о顕犖÷犖園犢犖犖犢犖犖犖犖犖犖犖項 犢犖犢犖 high PEEP 犢犖犢犖犖橿犖迦牽 challenge test
- #16: 犖犖謹犖犖園犖犖犖犖 calibration 犢犖÷厳犢犖犖о顕犖犖犖橿犖犖犢犖 transcuder 犖犖朽犖犖伍 phlebostatic axis 犢犖ム犖 犖犖÷幻犖 three way 犖犖犖 transducer 犖犢犖迦犖犖項犖犢犖о権 犢犖ム犖о犖犖巌犖犖伍 犖犖犖 close patient open to air 犖犖÷顕犖∇犖犖犖 犖犖о牽犖犖橿犖迦牽 flush 犖犖迦権 CVP 犖犖伍犢犖о牽 犢犖犖劇犖犖犢犖犖犖犖園犖犖迦牽犖犖伍犖犖園犖犖犖犖犖迦権 犢犖ム鍵 cribrate 犢犖÷厳犢犖 wave CVP 犢犖÷厳犢犖犖÷元犖犖迦牽 Overdamping 油