82: Central Venous Catheter Insertion (Assist)

PROCEDURE 82


Central Venous Catheter Insertion (Assist)





PREREQUISITE NURSING KNOWLEDGE




• Knowledge of the normal anatomy and physiology of the cardiovascular system is needed.


• Knowledge of the anatomy and physiology of the vasculature and adjacent structures of the neck, groin, and arm is necessary.


• Basic dysrhythmia interpretation should be understood.


• Understanding of aseptic technique is necessary. Prevention of infection is a significant concern for patients with indwelling catheters.


• Advanced cardiac life support knowledge and skills are needed.


• Indications for a central venous catheter include the following4,7:



• Relative contraindications of CVC insertion include the following4,7:



• The central venous pressure (CVP) provides information regarding right heart filling pressures and right ventricular function and volume.


• The CVP historically was measured with a water manometer system but now is measured with a single-pressure transducer system (see Procedures 70 and 76).


• The CVP waveform is identical to the right atrial pressure (RAP) waveform.


• The normal CVP value is 2 to 6 mm Hg.


• Electrocardiographic (ECG) monitoring is essential in determination of accurate interpretation of the CVP value.


• Understanding of a, c, and v waves is necessary. The a wave reflects right atrial contraction, the c wave reflects closure of the tricuspid valve, and the v wave reflects right atrial filling during ventricular systole (see Figs. 70-1 and 73-7).


• Dysrhythmias may alter CVP or RAP waveforms.


• The risk for a pneumothorax is minimized with use of an internal jugular vein. The preferred site for catheter insertion is the right internal jugular vein. The right internal jugular vein is a “straight shot” to the right atrium.

Jun 4, 2016 | Posted by in CRITICAL CARE | Comments Off on 82: Central Venous Catheter Insertion (Assist)

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