P&P CVP

Question 1

Positive deflections

Answer 1

a, c, v

Question 2

Negative deflections

Answer 2

x, y

Question 3

Corresponds with increase in RAP, atrium contracts

Answer 3

a wave

Question 4

Closed tricuspid valve bulges into right atrium at onset of ventricular systole

Answer 4

c wave

Question 5

ventricular systole as atrium relaxes and RAP decreases rapidly

Answer 5

x descent

Question 6

Filling of right atrium

Answer 6

v wave

Question 7

Tricuspid valve opens, atrium empties, drop in atrial pressure (early ventricular filling)

Answer 7

y descent

Question 8

no a wave, pronounced c wave

Answer 8

atrial fibrillation

Question 9

prominent c-v wave

Answer 9

tricuspid regurgitation

Question 10

Overall elevation of CVP waveform, absence of y descent

Answer 10

cardiac tamponade

Question 11

cannon ‘a’ waves

Answer 11

AV dissociation

Question 12

What are the components of a central venous pressure waveform and what does each represent?

Answer 12

a wave represents atrial contraction
c wave represents elevation of the tricuspid valve during ventricular contraction
v wave represents venous return against a closed tricuspid valve
x and y descents represent downward displacement of the ventricle during systole and opening of the tricuspid valve during diastole

Question 13

What condition could result in fusing of the A and V waves on a CVP waveform?

Answer 13

Decreased right ventricular compliance can cause the CVP to increase and the A and V waves can fuse to look like an ‘m’ or ‘w’ shape.

Question 14

What factors could cause a large V wave on a CVP waveform?

Answer 14

Large V waves on a CVP waveform can be caused by right ventricular ischemia, right ventricular failure, contrictive pericarditis, cardiac tamponade, papillary muscle ischemia, or tricuspid regurgitation.

Question 15

What conditions are most likely to produce large A waves on a CVP waveform?

Answer 15

Large A waves can be caused by tricuspid stenosis, right ventricular hypertrophy, lung disease with pulmonary hypertension, or decreased right ventricular compliance.

Question 16

What conditions are associated with an increased central venous pressure?

Answer 16

Right ventricular failure, tamponade, tricuspid stenosis, tricuspid regurgitation, pericarditis, pulmonary hypertension, chronic left ventricular failure, and hypervolemia.

Question 17

What conditions are associated with extremely large a waves (also called cannon a waves) on a CVP waveform?

Answer 17

Dysrhythmias such as junctional rhythms, complete AV block, or PVCs, triscupid or mitral stenosis, myocardial ischemia, diastolic dysfunction, ventricular pacing, and ventricular hypertrophy.

Question 18

What is the most common site for central venous cannulation by anesthesia providers?

Answer 18

RIJ

Question 19

What are the three descents that follow the a, c, and v waves on a central venous pressure waveform and what do they represent?

Answer 19

The x wave follows the a wave and represents the start of atrial diastole. The x1 descent occurs as a result of the downward pull of the ventricular septum during systole. The y descent represents the opening of the tricuspid valve.

Question 20

most commonly used catheter is a______multiport catheter that allows simultaneous monitoring and infusion of Rxs/IVF

Answer 20

7-Fr, 20-cm

Question 21

Why isnt LIJ used more often?

Answer 21

any catheter inserted from the left side of the patient must traverse the innominate (left brachiocephalic) vein and enter the superior vena cava perpendicularly

Question 22

Location preferred in trauma (patients in c-spine collar)

Answer 22

Subclavian

Question 23

Catheter tip should lie

Answer 23

within the superior vena cava

Question 24

Most common acute mechanical complication

Answer 24

unintended arterial puncture

Question 25

most important life-threatening vascular complication of CV catheterization is _______ resulting from ________

Answer 25

cardiac tamponade

resulting from: perforation of the intrapericardial superior vena cava, RA/RV

Question 26

most common complication of subclavian vein cannulation

Answer 26

pneumothorax

Question 27

most common major late complication of central venous cannulation

Answer 27

infection

Question 28

a wave occurs during?

Answer 28

end diastole

Question 29

c wave occurs during?

Answer 29

early systole

Question 30

v wave occurs during?

Answer 30

late systole

Question 31

h wave occurs during?

Answer 31

mid to late diastole

Question 32

x descent occurs during?

Answer 32

mid-systole

Question 33

y descent occurs during?

Answer 33

early diastole

Question 34

diastolic plateau

Answer 34

h wave

Question 35

three systolic components

Answer 35

c wave, x descent, v wave

Question 36

two diastolic components

Answer 36

y descent, a wave

Question 37

when should CVP be measured?

Answer 37

end expiration

Question 38

PVR=

Answer 38

80 * (MPAP-PAWP)/CO

Question 39

Loss of a wave

Answer 39

Ventricular pacing
Afib
Asystole

Question 40

Which of the following are associated with cannon 'a' waves on the central venous pressure waveform? (select two)
A. Aortic stenosis
B. Diastolic dysfunction
C. Atrial fibrillation
D. Complete atrioventricular block

Answer 40

B. Diastolic dysfunction

D. Complete atrioventricular block

Question 41

What are cannon a waves?

Answer 41

extremely large ‘a’ waves in a CVP waveform

Question 42

Which of the following conditions are associated with large 'v' waves on the central venous pressure waveform?
A. Aortic stenosis
B. Tricuspid regurgitation
C. Mitral stenosis
D. Hypovolemia

Answer 42

B. Tricuspid regurgitation

or… mitral regurgitation, or a sudden dramatic increase in intravascular volume