RAP/CVP Monitoring

Question 1

Why is RAP monitoring used?

Answer 1

to assess a patient’s CENTRAL VENOUS PRESSURE or FLUID VOLUME status

Question 2

How to measure RAP

Answer 2

either a central venous catheter
or
the proximal port of a pulmonary artery catheter
(also used for CVP)

Question 3

If using a central venous catheter, the line is placed WHERE by a physician most often?

Answer 3

superior or inferior vena cava

Question 4

Central venous catheters infuse fluids via

Answer 4

single, double, or multiple (triple) lumens

Question 5

Right atrial pressures are used to assess?

Answer 5

preload of the right heart,

the value of which reflects the fluid volume status of the patient

Question 6

RAP/CVP Measured values are used to guide?

Answer 6

1. ) fluid replacement and

2. ) assess the status of the right ventricle.

Question 7

Normal central venous pressures range between

Answer 7

2 and 6 mm Hg

Question 8

During breathing, Right atrial pressure is measured when?

Answer 8

on end exhalation

to ensure that pulmonary changes do not skew the numeric value

Question 9

RAP/CVP provide a direct measurement of what?

Answer 9

pressures in the right atrium

Question 10

Nursing Implications

Best Patient position for accurate BP ?

Answer 10

Head of bed between 0 and 60 degrees = accurate BP

Question 11

Nursing Implications

BP drops when the pt changes what position

Answer 11

sitting up

Question 12

Correlate values with assessment:

High CVP means

Answer 12

1. ) right sided failure,
2. ) pulmonary hypertension,
3. ) hypervolemia,
4. ) Vents,
5. ) vasconstriction

Question 13

Correlate values with assessment:

Low CVP means

Answer 13

1. ) hypovolemia,
2. ) vasodilation,
3. ) patient position

Question 14

Possible Complications of RAP/CVP Catheter Insertion

Answer 14

1. ) Infection
2. ) Pneumothorax or hemothorax
3. ) Carotid puncture
4. ) Heart perforation
5. ) Dysrhythmias

Question 15

Can the nurse: RAP/CVP Catheter Insertion?

Answer 15

NO

Question 16

Where is the RAP/CVP catheter inserted?

Answer 16

Inserted at subclavian

• a pair of large arteries in the thorax that supply blood to the thorax itself, head, neck, shoulder and arms

Question 17

How do you assess for Pneumothorax?

What are the expected findings?

Answer 17

Assess: lung sounds

• absent lung sounds (pneumo),
• diminished breath sounds

Question 18

Pneumothorax Assessment

What do you do if no breath sounds are heard?

Answer 18

call the HCP,

Expect

• x-ray order
• Chest tube placement

Question 19

Pneumothorax Assessment

Nursing interventions as you wait for x-ray/chest tubes?

Answer 19

• give O2,
• raise HOB 30-40 degress

(think of resp distress interventions = comfort and safety)

Question 20

Carotid puncture Assessment

What would this complication look like?

Answer 20

hematoma development/formation

Question 21

Carotid Puncture

Nurse Interventions

Answer 21

• apply pressure
• monitor site
• feel around the proximal area to make sure there is no hematoma build-up
• Then call for help

(* build-up would mean an arterial leak)
Then call for help

Question 22

Heart perforation Assessment

Expected finding?

Answer 22

• dysrhythmias
• arrhythmias
• chest pain
• pressure dropping