The Difference???

[VickyRN, MSN, DNP, RN]

Would some of you more experienced nurses highlight for me the difference between CVP and PAWP?

Know CVP indicates fluid status, venous. Also right ventricular preload.

Know PAWP indicates left ventricular preload, ideal is around 18--anything above that indicates left ventricle in not operating efficiently, heart failure.

Thanks for any other insights/explanations you can offer me

:D :kiss

[SICU Queen]

Here's what I know, and what I could find in my little pile of work-related resource stuff. It may not be much more detailed than what you said already...

CVP measures systemic venous pressure at the level of the right atrium, assesses fluid volume excess or deficit, provides information regarding RV (right ventricular) function and venous tone. Things that may increase CVP are RV failure, cardiac tamponade, fluid volume overload, pulmonary hypertension, and chronic LV failure. Decreased CYP is usually hypovolemia, but drugs and other things like sepsis that cause venodilation can also cause a decrease.

PAWP reflects LVEDP (left ventricular end-diastolic pressure). It evaluates cardiac performance. An increase is usually seen with LV failure, acute cardiac tamponade, and I think mitral regurg. A decrease would be seen with hypovolemia and afterload reduction. Also, PEEP >10 can cause a false high reading of all PA pressures. (We run into this on occasion with one cardiologist who comes in and messes with the vents when our CABGs roll out.)

Also, PAWP and PAD (pulmonary artery diastolic) in healthy patients usually correspond pretty closely, a difference can indicate pulmonary disease of some sort or a PE. The PAS and PAD would be elevated with the PAWP being normal.

Hope this helps a little, although like I said, you seemed to have hit most of it anyway... :) You might ought to ask Matt (the sushi whore guy), I think he works in a CVICU also, plus he seems extremely knowledgeable.

[VickyRN, MSN, DNP, RN]

Thank you!!! Helps me understand these concepts better.

[leeriza]

As far as I can remember, CVP are usually done to critically ill patients, or patients undergoing major surgical procedures so that sudden changes in pressure are immediately detected, trends in pressure change may be evaluated, and the effects of therapy may be assessed. Examples are, surgical procedures requiring cardiopulmonary bypass, major vascular, thorasic, abdominal, or neurologic procedures, all hemodynamically unstable patients, patient's receiving potent vasopressors, patient's supported on the IABP, patients receiving ICP monitoring, and patients with hypertensive crisis such as dissecting aortic aneurysm ans stroke. Also, having a CVP line is useful for series of blood tests.

PAWP on the other hand is more complex and seldom done (in my hospital). The physician will do PAWP monitoring to monitor mitral valve stenosis, LV failure, cardiac tamponade, dysrhythmias, mitral regurgitation, constrictive pericarditis, or hypervolemia.

Hope this help.