Central venous pressure
- Pressure in the right atrium
- Normal value 0-10 mmHg
- Useful for determining trend and response to fluid challenges
- Affected by: valvular heart disease,
- Central vein) is one without a valve - IJV, subclavian, femoral/iliac
[Response to fluid challenge]
Indications for central lines
- Short-term
- CVP measurements
- Pulmonary artery catherisation
- Fluid resuscitation
- Drug administration (irritant drugs - amiodarone, potassium, inotropes)
- Haemodialysis
- Cardiac pacing
- Long-term (reduced infection risk by "tunnelling" line)
- Venous blood sampling
- Drug administration - cytotoxics
- Feeding
Anatomical Landmarks
- IJV cannulation
- Trendelenberg head down
- Aimed towards two heads of sternocleidomastoid
- Subclavian cannulation
- Infraclavicular
- 2cm below mid-point of clavicle
- Needle directed towards suprasternal notch
Complications of central lines
- Arterial:
- inadvertant cannulation
- haemorrhage (subclavian artery very difficult to control)
- Stroke
- Venous:
- air embolism
- Thrombosis
- Pleural:
- Pneumothorax
- Lymphatic
- Chylothorax if thoracic duct affected
- Cardiac
- Right atrial perforation
- General:
- Sepsis