CUSTOMER CAREATTACHED CVP (venous CENTRAL PRESSURE)
INTRODUCTIONCVP catheter is poly ethylene from the edge of the vein so that the tip was in the right atrium or vena cava in the estuary. CVP central venous catheterization is also called (KVS).Nurses should pay attention to the subject:1. Prepare tools - tools2. Installation manometer on the standard infusion3. Specifies the zero point4. Replacing fluids5. Fixation6. Physiotherapy and mobilization
PURPOSE INSTALLATION CVP1. Knowing the central venous pressure (TVS)2. To provide total parenteral nutrition (TPN), an intravenous high-calorie foods3. To take venous blood4. To deliver drugs - drugs intra venous5. Giving fluids in large quantities in a short time6. Performed in patients with acute
CVP is not a stand-alone clinical parameters, should be assessed by parameters such as:The pulseBlood pressureVolume of bloodCVP reflects the amount of circulating blood volume in the patient's body, which is determined by the strength of heart muscle contraction. Eg: syock hypovolemic -> Low CVP
PREPARATION EQUIPMENT -1. The CVP manometer2. Central venous catheter3. Three way stopcock4. IV tube manometer5. Infusion sets6. Disposible syringe 10 cc / 20 cc7. Vena sectie set8. Duk hole sterile9. Sterile gauze pads10. Graduated and 10% alcohol or betadin11. Novocain lidocain 2% or 2%12. Infusion13. Plaster14. Scissors15. Water - pass16. IV pole17. Spalk18. Verband
HOW FITTINGa. Areas posted:Femoral veinVena cephalikaVena basalikaSubclavian veinExternal jugular veinInternal jugular vein
b. The assembly:People with sleep supine (trendelenberg)Left shoulder was given a pillowWear glovesDisinfection daearah CVPDoek hole pairsDecide where puncturesGive local anesthesiaMeasure how far the catheter insertedConnect the catheter tip 20 cc syringe filled with 2-5 cc of 0.9% NaClNeedles are inserted about - about 1 medial fore finger, ear toward the opposite sideBlood was sucked with syringeThe catheter is inserted into the needle continues, continues to be driven up to the superior vena cava or right atriumMandrin revoked then spliced infusion -> manometer with three way stopcockCatheter fixation on skinGive betadhin 10%Close sterile gauze and plaster
INSTALLATION OF PROFITS IN THE VEINS subclavian1. Easy to implement (diameter 1.5 cm - 2.5 cm)2. Fixation easy3. Menyengkan patients4. Do not disturb the routine care can be maintained up to 1 week
HOW TO ASSESS AND INSTALLING MANOMETER CVP1. How to determine the zero pointPeople with sleep supine horizontalUsing pliers hose filled with water ± half -> a circle with a separate watershedThe zero point of the patient associated with the water's edge on one side of the tube. On the other hand is placed on the manometer.Manometer zero point can be determinedManometer zero point is the point of the same height as the point V.cava superior flow, right atrial and inferior V.cava converge into one.
2. Assessment CVPCatheter, infusion, manometer connected with stopcock -> observe infusion smoothly or notPatient supineWe raise infusion into the manometer to the highest -> take care not to fluid outIntravenous fluids we close, by turning the stopcock connecting the manometer will enter the patient's bodyThe surface of the liquid in the manometer will drop and there undulasi appropriate rhythm of breath, down (inspiration), rose (expiration)Undulasi stop -> there limits Puspa -> CVPRated at number 7 -> 7 cmH2O CVPInfuse run again after it emerged CVP
VALUE CVPLow-value: <4 cmH2OThe normal value: 4-10 cmH2OValues were: 10 - 15 cmH2OHigh value:> 15 cmH2O
ASSESSMENT AND ARTI clinical CVPCVP is very significant in patients who experience shock and judgment are as follows:1. CVP is low (<4 cmH2O)Give blood or fluid droplets quickly.When normal CVP, shock signs missing -> hypovolemic shockWhen normal CVP, signs - signs of shock increases -> septic shock
2. Normal CVP (4-14 cmH2O)If blood or fluid with a heart - the heart and monitored its effect on circulation.When normal CVP, mark - mark negative shock -> hypovolemic shockWhen CVP increased up, mark a positive shock -> septic shock, shock cardiogenik
3. High CVP (> 15 cmH2O)Indicate a disorder of the heart (cardiac insufficiency)Therapy: kardiotonika drugs (dopamine)
FACTORS - FACTORS AFFECTING ASSESSMENT CVP1. Blood Volume:Total blood volumeThe volume of blood contained in the veinsThe speed of transfusion / liquid2. Heart failure and cardiac insufficiency3. Constricting the veins caused by neurological factors4. The use of drugs - drugs vasopresor5. Increased intraperitoneal pressure and pressure intrathoracal, eg:Postoperative illeusHematothoraksPneumothoraxThe use of mechanical ventilatorsMediastinal emphysema6. Pulmonary embolism - Pulmonary7. Pulmonary arterial hypertension8. Superior vena cava syndrome9. Lung diseases - chronic obstructive pulmonary10. Pericarditis constrictiva11. Artevac; blockage of the catheter, the catheter tip was in the inferior v.jugularis
