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Central venous pressure monitoring in critical care settings

25 February 2021
13 min read
Volume 30 · Issue 4

Abstract

Patients who present with acute cardiovascular compromise require haemodynamic monitoring in a critical care unit. Central venous pressure (CVP) is the most frequently used measure to guide fluid resuscitation in critically ill patients. It is most often done via a central venous catheter (CVC) positioned in the right atrium or superior or inferior vena cava as close to the right atrium as possible. The CVC is inserted via the internal jugular vein, subclavian vein or via the femoral vein, depending on the patient and their condition. Complications of CVC placement can be serious, so its risks and benefits need to be considered. Alternative methods to CVC use include transpulmonary thermodilution and transoesophageal Doppler ultrasound. Despite its widespread use, CVP has been challenged in many studies, which have reported it to be a poor predictor of haemodynamic responsiveness. However, it is argued that CVP monitoring provides important physiologic information for the evaluation of haemodynamic instability. Nurses have central roles during catheter insertion and in CVP monitoring, as well as in managing these patients and assessing risks.

Central venous pressure (CVP) monitoring is used to measure the pressure from the right atrium or superior vena cava, normally via a central venous catheter (CVC) usually known as a central line. CVP monitoring is helpful in determining the adequacy of circulating blood volume and cardiac preload (Shah and Louis, 2020).

The insertion of a CVC to measure CVP is an invasive method of assessing patients' fluid status in critical care settings (Hill, 2018). A CVC is a catheter with a tip that lies within the proximal third of the superior vena cava, the right atrium or the inferior vena cava. These catheters can be inserted through a peripheral vein or a proximal central vein (Hill, 2018). The CVP can then be monitored electronically by connecting the CVC to a cardiac monitor, allowing a transduced waveform to be seen alongside a regularly updated numerical value. This is often practicable in critical care because patients in these settings frequently have a CVC in situ, which can be easily connected to a cardiac monitor to measure CVP. CVP can also be measured manually using a water manometer; however, this method is rarely used in clinical practice now.

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