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Central venous pressure

Central venous pressure (CVP) is the blood pressure in the venae cavae, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial system. CVP is often a good approximation of right atrial pressure (RAP),[1] although the two terms are not identical, as a pressure differential can sometimes exist between the venae cavae and the right atrium. CVP and RAP can differ when arterial tone is altered. This can be graphically depicted as changes in the slope of the venous return plotted against right atrial pressure (where central venous pressure increases, but right atrial pressure stays the same; VR = CVP − RAP).

CVP has been, and often still is, used as a surrogate for preload, and changes in CVP in response to infusions of intravenous fluid have been used to predict volume-responsiveness (i.e. whether more fluid will improve cardiac output). However, there is increasing evidence that CVP, whether as an absolute value or in terms of changes in response to fluid, does not correlate with ventricular volume (i.e. preload) or volume-responsiveness, and so should not be used to guide intravenous fluid therapy.[2][3] Nevertheless, CVP monitoring is a useful tool to guide hemodynamic therapy. The cardiopulmonary baroreflex responds to an increase in CVP by decreasing systemic vascular resistance while increasing heart rate and ventricular contractility in dogs.[4]

Measurement

Site Normal
pressure range
(in mmHg)[5]
Central venous pressure 3–8
Right ventricular pressure systolic 15–30
diastolic 3–8
Pulmonary artery pressure systolic 15–30
diastolic 4–12
Pulmonary vein/

Pulmonary capillary wedge pressure

2–15
Left ventricular pressure systolic 100–140
diastolic 3–12

Normal CVP in patients can be measured from two points of reference:

CVP can be measured by connecting the patient's central venous catheter to a special infusion set which is connected to a small diameter water column. If the water column is calibrated properly the height of the column indicates the CVP.

In most intensive care units, facilities are available to measure CVP continuously.

Normal values vary between 4 and 12 cmH2O.

Factors affecting CVP

Factors that increase CVP include:

Factors that decrease CVP include:

See also

References

  1. ^ "Central Venous Catheter Physiology". Archived from the original on 2008-08-21. Retrieved 2009-02-27.
  2. ^ Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. (2004). "Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects" (PDF). Crit Care Med. 32 (3). doi:10.1097/01.ccm.0000114996.68110.c9.
  3. ^ Marik P, Baram M, Vahid B (July 2008). "Does Central Venous Pressure Predict Fluid Responsiveness?" (PDF). Chest. 134 (1): 1351. doi:10.1378/chest.08-1846.
  4. ^ Sala-Mercado JA, Moslehpour M, Hammond RL, Ichinose M, Chen X, Evan S, O'Leary DS, Mukkamala R (June 2014). "Stimulation of the Cardiopulmonary Baroreflex Enhances Ventricular Contractility in Awake Dogs: A Mathematical Analysis Study". American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 307 (4): R455–R464. doi:10.1152/ajpregu.00510.2013. PMC 4137157.
  5. ^ Table 30-1 in: Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow (2008). The Washington manual of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-7447-0.

External links