Place : College of Nursing, MMC, Madurai

Name of the Subject : Medical Surgical Nursing

Group of student s :
Name of Topic : Central Venous Pressuree
Date :
Time :
Venue : Male Medical Ward
Methods of teaching : Lecture cum demonstration
Teaching Aids : Roller board, Charts, Handout
Name of the student teacher : Raj Kumar.K
Placement : M.Sc., Nursing I year
Name of the Guide / Evaluator : Mrs. S.MUNIAMMAL, M.Sc (N)
Lecturer, College of Nursing,
Madurai Medical College,
Madurai - 20

CENTRAL OBJECTIVE

Enable the student should be able to obtain or acquire knowledge and skills regarding the

Central Venous Pressure and develop desirable attitudes and skills towards Central Venous Pressure.
CONTRIBUTORY OBJECTIVES:

At the end of the demonstration the students will be able to,

 define the term “central venous pressure”

 enlist the sites of inserting central venous catheter

 what are the types of central venous catheter

 list out the indications for central venous catheter

 explain is the procedure performed

 how to measure the central venous pressure

 enumerate the factors affecting central venous pressure

 determine the complication of central venous pressure

INTRODUCTION:

A catheter that is placed into a large vein. Catheters can be placed in veins in the neck (internal jugular
vein), chest (subclavian vein or axillary vein), groin (femoral vein), or through veins in the arms (also known as a PICC
line, or peripherally inserted central catheters). It is used to administer medication or fluids that are unable to be taken by
mouth or would harm a smaller peripheral vein, obtain blood tests (specifically the "central venous oxygen saturation"), and
measure central venous pressure.

Yes, that is the Central Venous Pressure topic, we are going to discuss in detail.

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1 3 mts define central Central venous pressure (CVP)
S.N TIM CONTRIBUTOR STUDENT AV LEARNER’ EVALUATION
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venous pressure is the blood pressure in the venae cavae, Explaining Roller Listening and What is mean by
near the right atrium of the heart. CVP board clearing central venous
reflects the amount of blood returning to doubts pressure?
the heart and the ability of the heart to
pump the blood back into the arterial
system. CVP is often a good
approximation of right atrial pressure
(RAP), al though the two terms are not
identical, as a pressure differential can
sometimes exist between the venae cavae
and the right atrium. CVP and RAP can
differ when arterial tone is altered. This
can be graphically depicted as changes in
the slope of the venous return plotted
against right atrial pressure (where
central venous pressure increases, but
right atrial pressure stays the same;

VR = CVP − RAP).

S.N TIME CONTRIBUTOR STUDENT LEARNER’ EVALUATION

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5 mts
What are the site
2. enlist the sites of SITES OF CENTRAL VENOUS CATHETER Explaining Listening inserting central
inserting central venous catheter?
venous catheter  internal jugular vein,

 subclavian vein or axillary vein,

 femoral vein, or

 through veins in the arms (also

known as a PICC line, or
peripherally inserted central
cathetersPrimary seeks to prevent
the occurrence of mental disorders
by strengthening individual ,
family and group coping abilities.
5 mts List out the type
3. what are the types Explaining Listening and of central venou
of central venous taking notes catheter?
catheter and
TYPES OF CENTRL VENOUS answering
CATHER questions

EVALUATION
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S.N TIME CONTRIBUTOR STUDENT AV LEARNER’
O Y OBJECTIVES Non-tunneled vs. tunneled catheters TEACHER’S AIDS S
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CONTENT

Non-tunneled catheters are fixed in

place at the site of insertion, with the
catheter and attachments protruding
directly. Commonly used non-tunneled
catheters include Quinton catheters.

Tunneled catheters are passed

under the skin from the insertion site to a
. separate exit site. The catheter and its
attachments emerge from underneath the
skin. The exit site is typically located in
the chest, making the access ports less
visible than catheters that protrude
directly from the neck. Passing the
catheter under the skin helps to prevent
infection and provides stability.
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Commonly used tunneled catheters

TIME include Hickman catheters and Groshong STUDENT
CONTRIBUTOR catheters. TEACHER’S A V LEARNER’ EVALUATION
S.N Y OBJECTIVES ACTIVITY AIDS S
O Implanted port ACTIVITY
A port is similar to a
tunneled catheter but is left entirely

CONTENT

under the skin. Medicines are injected

through the skin into the catheter.
Some implanted ports contain a small
reservoir that can be refilled in the
same way. After being filled, the
reservoir slowly releases the medicine
into the bloodstream. An implanted
port is less obvious than a tunneled
catheter and requires little daily care.
It has less impact on a person's
activities than a PICC line or a
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tunneled catheter.

PICC line
TIME
A peripherally inserted central STUDENT
S.N catheter, or PICC line (pronounced TEACHER’S LEARNER’ EVALUATION
O 3 mts CONTRIBUTOR "pick"), is a central venous catheter ACTIVITY S
Y OBJECTIVES inserted into a vein in the arm (via the ACTIVITY
basilic or cephalic veins) rather than a Name any five
vein in the neck or chest. The tip is indications of
4. list out the positioned in the superior vena cava Explaining Listening and central venous
indications of answering pressure?
central venous questions
pressure

CONTENT

INDICATIONS

 Long-term intravenous antibiotics

 Long-term parenteral nutrition,
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especially in chronically ill persons
 Long-term pain medications
 Chemotherapy
 Drugs that are prone to cause
phlebitis in peripheral veins
(caustic), such as:
TIME
o Calcium chloride
o Chemotherapy STUDENT
CONTRIBUTOR o Hypertonic saline TEACHER’S LEARNER’ EVALUATION
S.N Y OBJECTIVES o Potassium chloride (KCl) ACTIVITY S
O o Amiodarone ACTIVITY
o Vasopressors (for example,
epinephrine, dopamine)
 Plasmapheresis
 Peripheral blood stem cell
collections
 Dialysis
5.

CONTENT
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 Frequent blood draws

5.  Frequent or persistent How to perform
explain the requirement for intravenous Explaining the central veno
procedure of access Listening and pressure?
central venous  Need for intravenous therapy answering
TIME catheter when peripheral venous access is questions
impossible
o Blood
S.N STUDENT EVALUATION
o Medication
O CONTRIBUTOR TEACHER’S LEARNER’
Y OBJECTIVES o Rehydration ACTIVITY S
 Monitoring of the central venous ACTIVITY
pressure (CVP) in acutely ill
people to quantify fluid balance.

PROCEDURE

Before insertion, the patient is first

assessed by reviewing relevant labs and
indication for CVC placement, in order
to minimize risks and complications of
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the procedure. Next, the area of skin ove

CONTENT

r the planned insertion site is cleaned. A

local anesthetic is applied if necessary.
TIME The location of the vein is identified by
landmarks or with the use of a small
ultrasound device. A hollow needle is
advanced through the skin until blood is
S.N aspirated. The color of the blood and the STUDENT EVALUATION
O CONTRIBUTOR rate of its flow help distinguish it from TEACHER’S LEARNER’
Y OBJECTIVES arterial blood (suggesting that an artery ACTIVITY S
has been accidentally punctured). Within ACTIVITY
North American and Europe, ultrasound
use now represents the gold standard for
central venous access and skills, with
diminishing use of landmark techniques.
Recent evidence shows that ultrasound-
guidance for subclavian vein
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catheterization leads to a reduction in

adverse events.

The line is then inserted using the

Seldinger technique: a blunt guidewire is
passed through the needle, then the

CONTENT
TIME

needle is removed. A dilating device

may be passed over the guidewire to
expand the tract. Finally, the central line
itself is then passed over the guidewire, STUDENT
S.N which is then removed. All the lumens of TEACHER’S
O CONTRIBUTOR the line are aspirated (to ensure that they ACTIVITY
Y OBJECTIVES are all positioned inside the vein) and
flushed with either saline or heparin.[1] A
chest X-ray may be performed
6. afterwards to confirm that the line is Explaining
how tomeseaure positioned inside the superior vena cava
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the central venous
pressure and no pneumothorax was caused
inadvertently. On anteroposterior X-rays,
a catheter tip between 55 and 29 mm
below the level of the carina is regarded
as acceptable placement.[23]
Electromagnetic tracking can be used to
verify tip placement and provide
guidance during insertion, obviating the
need for

TIME CONTENT

the X-ray afterwards.

STUDENT
S.N MEASURMENT TEACHER’S
O CONTRIBUTOR ACTIVITY
Y OBJECTIVES Normal CVP can be measured from two
points of reference:
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 Sternum: 0–14 cm H2O

 Midaxillary line: 8–15 cm H2O

CVP can be measured by connecting the

patient's central venous catheter to a
special infusion set which is connected
to a small diameter water column. If the
water column is

calibrated properly the height ofcolumn

indicates the CVP.

In most intensive care units, facilities

are available to measure CVP

continuously.
TIME

CONTENT

STUDENT
S.N Normal values vary between 4 and 12 TEACHER’S
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O CONTRIBUTOR ACTIVITY
Y OBJECTIVES cmH2O.

Normal
pressure
Site range
(in mmHg)
[5]

Central venous pressure 3–8

Right systolic 15–30
ventricular
diastolic 3–8
pressure
systolic 15–30
Pulmonary 4–12
artery pressure diastolic
CONTENT

TIME Pulmonary vein/

2–15
Pulmonary capillary
wedge pressure
Left ventricular systolic 100–140
pressure diastolic 3-12
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FACTORS AFFECTING CVP
STUDENT
S.N Factors that increase CVP include: TEACHER’S
O CONTRIBUTOR ACTIVITY
Y OBJECTIVES  Cardiac tamponade
 Decreased cardiac output
 forced exhalation
 Heart failure
 Hypervolemia
 Mechanical ventilation and the
application of positive end-
expiratory pressure (PEEP)
 Pleural effusion

CONTENT

 Pulmonary Embolism
TIME
 Pulmonary Hypertension
 Tension pneumothorax

Factors that decrease CVP include:

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 Deep inhalation
 Distributive shock
 Hypovolemia
STUDENT
S.N COMPLICATIONS TEACHER’S
O CONTRIBUTOR ACTIVITY
Y OBJECTIVES  Pneumothorax

 Bloodstream infections

 Thrombosis

 Misplacement

Other complications

 negative Intra-thoracic pressure

 Air embolisms

 Hemorrhage
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CONTENT

Uncommonly, the vein can fuse

with the artery after being damaged by

insertion of the catheter. Ultrasound use

is efficient at preventing this
complication.
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SUMMARY:

So for we discussed about define central venous pressure, sites of catheter insertion, types of cvp catheter,
indication and insertion of central venous cather, measurement of cvp pressure, factors affecting cvp pressure and
complications of central venous catheter are which help to acquire knowledge to attain the skill. Provision of immediate
feed back, regarded as student centered method, and hampering the creativity of the student by modeling.

CONCLUSION:

By this procedure demonstration students able to gain knowledge and skills of central venous pressure, I thank
our principal madam, Mrs .S .POONGUZHALI, M.Sc [N], MBA, M.A, Ph.D [N], Mrs. S.Muniammal, M.Sc(N),
Lecturer in Medical Surgical Nursing, College Of Nursing, MMC, Madurai-20.
BIBLIOGRAPHY:
Book reference
1. Brunner and suddharth, 2010, a textbook of medical surgical nursing, 11 th edition published by lippincot at New
Delhi
2. Lewis, 2015, A textbook of medical surgical nursing, 2nd south asian edition, elesiver publishers at New Delhi
3. Black, J.M. & Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical Management for Positive Outcomes (8th ed.).
Philadelphia: Elsevier/Saunders.

4. Hinkle, J.L., & Cheever, K.H. (2014). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th ed.).
Philadelphia: Lippincott Williams & Wilkins.