Page 2467 - Saunders Comprehensive Review For NCLEX-RN

angioplasty (PTCA) or coronary artery
bypass graft.
h. Monitor arterial blood gas levels and
prepare to treat imbalances.
i. Monitor urinary output.
j. Assist with the insertion of a pulmonary
artery (Swan-Ganz) catheter to assess
degree of heart failure (Fig. 69-28).
B. Hemodynamic monitoring: includes central venous pressure
(CVP), pulmonary artery pressures, and mean arterial pressure
(MAP) (see Fig. 69-28)

C. Central venous pressure (CVP)

1. The CVP is the pressure within the superior vena cava;
it reflects the pressure under which blood is returned
to the superior vena cava and right atrium.
2. The CVP is measured with a central venous line in the
superior vena cava.
3. Normal CVP pressure ranges between approximately
3 to 8 mm Hg.
4. An elevated CVP indicates an increase in blood
volume as a result of sodium and water retention,
excessive IV fluids, alterations in fluid balance, or
kidney failure.
5. A decreased CVP indicates a decrease in circulating
blood volume and may be a result of fluid
imbalances, hemorrhage, or severe vasodilation, with
pooling of blood in the extremities that limits venous
return.

D. Measuring CVP

1. The right atrium is located at the midaxillary line at
the fourth intercostal space; the zero point on the
transducer needs to be at the level of the right atrium.
2. The client needs to be relaxed; activity that increases
intrathoracic pressure, such as coughing or straining,
will cause false increases in the readings.
3. If the client is on a ventilator, the reading should be
taken at the point of end-expiration.
4. To maintain patency of the central venous line, a
continuous small amount of fluid is delivered under
pressure.
E. Pulmonary artery pressures
1. A pulmonary artery catheter is used to measure right
heart and indirect left heart pressures.
2. Pulmonary artery wedge pressure (PAWP) is also
known as pulmonary artery occlusive pressure

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