82: Central Venous Catheter Insertion (Assist)

PROCEDURE 82


Central Venous Catheter Insertion (Assist)




PURPOSE: 


Central venous catheters are inserted to measure and obtain right atrial pressure and central venous pressure with jugular or subclavian catheter placement. Clinically useful information can be obtained about right ventricular preload, cardiovascular status, and fluid balance in patients who do not need pulmonary artery pressure monitoring. Central venous catheters also are placed for infusion of vasoactive medications, total parenteral nutrition, hemodialysis access, and the use of pulmonary artery catheters. In addition, central venous catheters are used to administer medication and intravenous products to patients with limited peripheral intravenous access and to provide access for pulmonary artery catheters and transvenous pacemakers.



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.

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

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