Central Line Placement and CVP

Question 1

Where is CVP located? And what’s its normal value according to the lecture?

Answer 1

in the vena cava at the junction with the right atrium. It’s normal value is 10 (8~12)mmHg

Question 2

The CVP reflects ___(left/right?) heart function and is not a reliable indicator of ___(left/right?) ventricular performance.

Answer 2

Right; Left

Question 3

If ____decreases, the CVP decreases.

Answer 3

right side preload

Question 4

Know where all the waves and descents are on the graph

Answer 4

Question 5

What are some common insertion sites for central line

Answer 5

Internal jugular: left or right; Sublcavian; Femoral; Brachial

Question 6

What’s the proper way to prep for CVP with cholrhexidine?

Answer 6

Use back and force motion for 30sec for dry area and 2min for moist area

Question 7

What are some factors that can affect CVP?

Answer 7

cardiac performance, blood volume, vascular tone, increased intra-abdominal or intrathoracic pressures and vasopressor therapy

Question 8

What does A wave indicate and where does it correspond to EKG?

Answer 8

atrial contraction; Occurs right after P wave on the ECG

Question 9

What would cause A wave to increase?

Answer 9

Tricuspid Stenosis; RVH; Pulmonary Stenosis; Pulmonary Hypertension; Giant A Waves-Cannon: AV block-RA contracts against a closed tricuspid valve

Question 10

What does C wave indicate and where does it correspond to EKG?

Answer 10

Caused by elevation of tricuspid valve into the right atrium during early ventricular/systolic contraction; Corresponds to the end of the QRS on the ECG

Question 11

What does X descent indicate and where does it correspond to EKG?

Answer 11

The X descent results from an atrial relaxation and downward displacement of the tricuspid valve during ventricular systole. Occurs during ST segment on the EKG

Question 12

When would X descent disappear?

Answer 12

in tricuspid regurgitation

Question 13

What does V wave indicate and where does it correspond to EKG

Answer 13

Caused by pressure produced when the blood filling the right atrium hits against a closed tricuspid valve; Corresponds to the end of the T wave on the ECG

Question 14

What happens to V wave in Tricuspid Regurgitation?

Answer 14

Prominent V waves

Question 15

What does Y descent indicate and where does it correspond to EKG

Answer 15

Produced by blood flowing into the right ventricle through an open tricuspid valve; Occurs before the P wave (prior to atrial contraction) on the ECG

Question 16

Indications for CVP?

Answer 16

To monitor pre-load; Hypovolemia ; Shock; Aspiration of Air Emboli; TPN; Insertion of transcutaneous pacing leads; IV access in patients with poor peripheral veins; Infusion of vasoactive medications

Question 17

Contraindications for CVP?

Answer 17

Tumors in the right atrium; Severe Coagulopathy; Ipsilateral carotid endarterectomy

Question 18

Complications can be caused by central line placement

Answer 18

Pneumothorax; Carotid Artery Puncture; Hemothorax from Vascular rupture; Air Embolism, wire embolization, thrombosis; Cardiac Perforation; Hematoma; Cardiac Tamponade; Arrhytmias, Hydrothorax, Chylothorax; Infection