Nursing Performance Checklist

Central Venous Pressure

Student Name_________________________:

Purpose :a. To serve as guide for fluid replacement. b. To monitor pressure in the right atrium and central veins.c. To administer blood products, TPN and drug therapy contraindicated for peripheral infusion. d. To obtain venous access when peripheral veins sites inadequate.e. To insert a temporary pacemaker. f. To obtain central venous blood sampler.

Equipment : 1-CVPkit

2-Flush system composed of intravenous solution [ contain heprain],tubing ,stopcocks and flush device

3-Pressure bag place around the flush solution is maintained 300 mmgh pressure , pressurized flush system delivers 3 to 5 ml solution per hours through cathter to prevent clotting.

4 -Transducer to convert the pressure from right atrium into electrical signal.5-Monitor which increase size of signal for display on oscilloscope.

6 -IV pole.Not doneDoneSteps of procedure:

incompletecompleteFor insertion:

1 -Explain the procedure to patient. 2 -Position patient appropriately . ( supine position)

3 -Flush IV infusion set and manometer.4-Place ECG monitoring.

5*-The CVP site is surgically cleaned . 6-Assist the patient to remaining

motionless during insertion. 7 *-Monitor for dysrhythmias ,tachypnea,

tachycardia as catheter is threaded to great veins. 8 -Connect primed IV tubing to catheter and allow

IV solution to flow.9* -The catheter should be suture in place . 10 -Place a sterile occlusive dressing over site .

11 *-Obtain a chest x-ray.

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Cont…steps of procedure:

incompletecomplete :To measure CVP

1 -Place the patient in supine position. 2 -Position the zero point of the manometer should

be on level with the patient right atrium . 3 -Turn the stopcock so the IV solution

flow into manometer ,to about 20 – 25 cm level . And the turn stopocock so the solution

in manometer flow to the patient.4 -Record the level the at which the solution

stabilizes. This CVP reading 5 -CVP catheter connect to transducer and electrical

monitor with CVP wave readout. 6 -CVP may range from 5 to 12 cmH2O of

or 2 to 6 mm Hg .7 -Assess patient condition.

8 -Turn the stopcock again to allow IV solution to follow to patient veins and should

monitor infusion hourly. phase : Follow-up

1 -Prevent and observe for complication. a. From catheter insertion : pneumothorax.

hemothorax , air embolism . hematoma and cardic temponade.

b. From indwelling catherer : infection , air embolism, central venous thrombosis.

2 -Make sure cap is secure3 -If air embolism is suspected , immediately place

patient in left lateral trendelenburg position and administer O2. 4- Carry out ongoing nursing intervention of the insertion site and maintain aseptic technique:

a. Inspect site twice daily for signs of local inflammation and phlebitis , Remove the catheter

immediately if there are signs of infection . b. Make sure sutures are intact

c. Change dressing as prescribed.d. label to show date and time of change.e. Send the catheter tip for bacteriological culture.

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Cont… Steps of Procedure:

incompleteComplete 5 -When discontinued , remove

central line.a. Position patient flat with head down.b. Remove dressing and suture.c. Have patient take deep breath.d. Apply pressure at catheter site

e. Monitor site and vital signs for signs of bleeding or hematoma formation.

Supervised by______________________________ :

Comments_________________________________ :

*steps done by physician.

Miss Aisha Alhofaian,2008

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