How to use central venous pressure measurements

McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.
Current Opinion in Critical Care (Impact Factor: 2.62). 07/2005; 11(3):264-70. DOI: 10.1097/01.ccx.0000163197.70010.33
Source: PubMed


Central venous pressure is a very common clinical measurement, but it is frequently misunderstood and misused. As with all hemodynamic measurements, it is important to understand its basic principles.
This analysis indicates that it is best to always consider the significance of central venous pressure in the context of the corresponding cardiac output. Even more important is the use of dynamic measures to interpret the meaning of the central venous pressure. This includes the hemodynamic response to fluid load, respiratory variations in central venous pressure, and even the change in central venous pressure with changes in the patient's overall status.
The clinical application of central venous pressure measurement requires a good understanding of the concept of the interaction of the function of the heart with the function of the return of blood to the heart.

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Available from: Sheldon Magder
    • "There are several physiological and anatomical factors that can influence CVP measurement and waveform during liver surgery, such as the vascular tone which were shown in our study results to be markedly reduced post-resection and also the intrathoracic pressure changes from the continuous effect of the surgical retractors on the diaphragm. The twisting the portal vein or inferior vena cava during manipulation or mobilization of the liver to help expose the tumor can lead to a reduction in venous return and reduce the CVP readings.[2728] Continuous CVP can help only to define the relative trending toward hypervolemia. "
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    ABSTRACT: Major hepatic resections may result in hemodynamic changes. Aim is to study transesophageal Doppler (TED) monitoring and fluid management in comparison to central venous pressure (CVP) monitoring. A follow-up comparative hospital based study. 59 consecutive cirrhotic patients (CHILD A) undergoing major hepatotomy. CVP monitoring only (CVP group), (n=30) and TED (Doppler group), (n=29) with CVP transduced but not available on the monitor. Exclusion criteria include contra-indication for Doppler probe insertion or bleeding tendency. An attempt to reduce CVP during the resection in both groups with colloid restriction, but crystalloids infusion of 6 ml/kg/h was allowed to replace insensible loss. Post-resection colloids infusion were CVP guided in CVP group (5-10 mmHg) and corrected flow time (FTc) aortic guided in Doppler group (>0.4 s) blood products given according to the laboratory data. Using the FTc to guide Hydroxyethyl starch 130/0.4 significantly decreased intake in TED versus CVP (1.03 [0.49] versus 1.74 [0.41] Liter; P<0.05). Nausea, vomiting, and chest infection were less in TED with a shorter hospital stay (P<0.05). No correlation between FTc and CVP (r=0.24, P > 0.05). Cardiac index and stroke volume of TED increased post-resection compared to baseline, 3.0 (0.9) versus 3.6 (0.9) L/min/m(2), P<0.05; 67.1 (14.5) versus 76 (13.2) ml, P<0.05, respectively, associated with a decrease in systemic vascular resistance (SVR) 1142.7 (511) versus 835.4 (190.9) dynes.s/cm(5), P<0.05. No significant difference in arterial pressure and CVP between groups at any stage. CVP during resection in TED 6.4 (3.06) mmHg versus 6.1 (1.4) in CVP group, P=0.6. TED placement consumed less time than CVP (7.3 [1.5] min versus 13.2 [2.9], P<0.05). TED in comparison to the CVP monitoring was able to reduced colloids administration post-resection, lower morbidity and shorten hospital stay. TED consumed less time to insert and was also able to present significant hemodynamic changes. Advanced surgical techniques of resection play a key role in reducing blood loss despite CVP more than 5 cm H2O. TED fluid management protocols during resection need to be developed.
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    • "A healthy person can have a CVP less than zero in upright position and still have an adequate CO and be euvolemic. Conversely, CVP can be high in a patient with poor ventricular function and low cardiac output or with a good ventricular function and volume overload [6]. As illustrated by these common scenarios, values derived from pressure readings are most useful when used in conjunction with a dynamic clinical response such as blood pressure or urine output, or some measure of cardiac output. "
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    ABSTRACT: Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.
    Full-text · Article · Jul 2011 · Anesthesiology Research and Practice
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    • "Furthermore, CVP may not be meaningful for patients who are in the prone or lateral decubitus positions (Soliman et al. 1998). A malpostioned pressure transducer can also significantly change CVP measurements (Magder 2005). Therefore, in these clinical situations, TSVR i may be advantageous over SVR i due to the possible inaccuracy of CVP. "
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    ABSTRACT: A clinical comparison, of two methods of afterload assessment, has been made. The first method, systemic vascular resistance index (SVR(i)), is based upon the traditional formula for afterload which utilizes central venous pressure (CVP), as well as cardiac index (C(i)), and mean arterial blood pressure (MAP). The second method, total systemic vascular resistance index (TSVR(i)), also uses MAP and C(i). However, TSVR(i) ignores the contribution of CVP. This preliminary examination, of 10 randomly-selected ICU patients, has shown a high degree of correlation (ranging from 90 to 100%) between SVR(i) and TSVR(i) (P < 0.0001). Furthermore, there was also a high degree of correlation (ranging from 94 to 100%) noted between the hour-to-hour change in SVR(i) with the hour-to-hour change in TSVR(i) (P < 0.0001). The results, of this pilot study, support the premise that the use of CVP may not always be necessary for afterload evaluation in the clinical setting. Minimally-invasive means of measuring both C(i) and MAP, without CVP, may be adequate for use in assessing afterload.
    Preview · Article · Dec 2010 · Cardiovascular Engineering
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