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Central Venous Pressure

Aka: Central Venous Pressure, CVP, Right Atrial Pressure, Right Ventricular End-Diastolic Pressure, RVEDP, Right Ventricular Filling Pressure
  1. Definitions
    1. Central Venous Pressure (CVP)
      1. Grouping of venous pressures that are equivalent to one another
        1. Superior Vena Cava Pressure
        2. Right Atrial Pressure (RAP)
      2. CVP is also equivalent to the right ventricular end diastolic pressure (RVEDP)
        1. Only if no tricuspid insufficiency
    2. Right Ventricular End-Diastolic Pressure (RVEDP)
      1. Equivalent to CVP (in the absence of tricuspid insufficiency)
  2. Technique: Central Venous Pressure (CVP)
    1. Catheters
      1. Central venous catheter or
      2. Pulmonary artery catheter (Swans-Ganz Catheter) via proximal port in atrium
      3. PICC Lines are not used for CVP measurement due to long length (but theoretically could be used with saline infusion)
        1. Black (2000) Crit Care Med 28:3833-36 [PubMed]
    2. Transducer
      1. Fluid-filled device measures pressure readings from catheter
      2. Placed at the same level as the right atrium
        1. Landmarks for the supine patient
          1. Intersection of the fourth intercostal space and the mid-axillary line
        2. Landmarks for the semi-recumbent patient (<60 degrees)
          1. Below the sternal angle by 5 cm (directly down)
    3. Measurement
      1. Record at the end of expiration (when intrathoracic pressure is closest to atmospheric pressure)
  3. Interpretation
    1. Normal Central Venous Pressure (CVP)
      1. Normal CVP 0-5 mmHg
      2. Measurements vary as much as 4 mm Hg in the same patient under the same conditions
        1. CVP change is only significant if changes more than 4 mmHg
    2. CVP may be increased initially despite significant volume depletion
      1. Consider underlying COPD, Vasoconstriction
      2. Peristently increased CVP suggests adequate volume replacement or Fluid Overload
    3. CVP that is markedly increased
      1. Fluid Overload or Cardiomyopathy
      2. Cardiac Tamponade
      3. Tension Pneumothorax
      4. Central catheter malposition
    4. CVP that is low with signs of shock and minimally rises with fluid bolus
      1. Continue Fluid Replacement (or Blood Products in the case of Hemorrhagic Shock)
      2. Consider source of ongoing losses
    5. CVP that is decreasing with signs of shock
      1. Aggressively search for ongoing losses (e.g. Hemorrhagic Shock)
      2. Continue Fluid Replacement (or Blood Products in the case of Hemorrhagic Shock)
  4. Precautions
    1. CVP is an indirect, invasive and often inaccurate surrogate for Ventricular Preload and volume status
      1. Consider Inferior Vena Cava Ultrasound for Volume Status as an alternative
    2. End diastolic pressure (e.g. CVP and Wedge Pressure) correlates poorly with end diastolic volume even in healthy patients
      1. Hence CVP and Wedge Pressure are unreliable markers of ventricular filling and volume status
    3. Falsely elevated with increased intrathoracic pressure (e.g. PPV, PEEP)
  5. References
    1. Marino (2014) ICU Book, 4th Ed Wolters-Kluwer p. 157-9
    2. (2012) ATLS Manual, 9th ed, American College of Surgeons

Central venous pressure (C0428640)

Definition (MSHCZE) Venózní tlak měřený v oblasti centrálních žil (např. podklíčkové) při současném zavedení centrálního katetru. Poskytuje cenné informace o stupni hydratace a žilního návratu (patří k základním údajů v intenzivně léčbě těchto stavů). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) The blood pressure in the central large VEINS of the body. It is distinguished from peripheral venous pressure which occurs in an extremity.
Concepts Clinical Attribute (T201)
MSH D002496
SnomedCT 71420008
English Central Venous Pressure, Central Venous Pressures, Pressure, Central Venous, Pressures, Central Venous, Venous Pressure, Central, Venous Pressures, Central, Central venous pulse pressure, central pressure venous, central venous pressures, central venous pressure, CVP - Central venous pressure, Central venous pressure (observable entity), Central venous pressure
Swedish Centralt ventryck
Czech centrální venózní tlak, centrální žilní tlak
Finnish Keskuslaskimopaine
French PVC (Pression Veineuse Centrale), Pression veineuse centrale
Russian VENOZNOE DAVLENIE TSENTRAL'NOE, TSENTRAL'NOE VENOZNOE DAVLENIE, ВЕНОЗНОЕ ДАВЛЕНИЕ ЦЕНТРАЛЬНОЕ, ЦЕНТРАЛЬНОЕ ВЕНОЗНОЕ ДАВЛЕНИЕ
Japanese 中心静脈圧
Spanish presión central del pulso venoso, presión venosa central (entidad observable), presión venosa central, Presión Venosa Central
Polish Ciśnienie żylne ośrodkowe, Ośrodkowe ciśnienie żylne
Norwegian Sentralt venetrykk
German Venendruck, zentraler, Zentraler Venendruck
Italian Pressione venosa centrale
Dutch Centraal-veneuze druk, Druk, centraal-veneuze
Portuguese Pressão Venosa Central
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Right atrial pressure (C0456165)

Concepts Laboratory or Test Result (T034)
SnomedCT 276755008
English right atrial pressure, atrial pressures right, RA - Right atrial pressure, Right atrial pressure, RAP - Right atrial pressure, Right atrial pressure (observable entity)
Spanish presión de aurícula derecha (entidad observable), presión de aurícula derecha
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Right ventricular end-diastolic pressure (C0456183)

Concepts Laboratory or Test Result (T034)
SnomedCT 276774000
English RVEDP-Rt ventric end-dias pres, Right ventric end-diast press, RVEDP - Right ventricular end-diastolic pressure, Right ventricular end-diastolic pressure, Right ventricular end-diastolic pressure (observable entity)
Spanish presión de fin de diástole del ventrículo derecho (entidad observable), presión de fin de diástole del ventrículo derecho
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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