CVP Line Question

  1. Hi! Need some assistance here...How do you position a patient 24hrs post-op whose CVP line was accidentally disconnected. Patient is in respi distress and hypotensive. Please help!
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  2. 21 Comments

  3. by   mcleanl
    Need more info....post-op form what and did the resp distress and hypotension occur secondary to the central line being pulled out?
  4. by   swaymaiway
    There was no further info given....it was given as a question as to how should a nurse position a patient who is hypotensive and with respiratory distress whose CVP Line was accidentally disconnected. for one, i know that patients with CVP are not supposed to be positioned head raised/elevated...am i right?
  5. by   traumaRUs
    I'm going to move this thread to the ICU forum because I think you would get more answers there.
  6. by   cardiacRN2006
    Trendellenburg on the left side.
    It keeps the air in the apex of the ventricle, and prevents its ejection into the pulmonary arterial system.
  7. by   mcleanl
    Now I see the question is really referring to an air embolus secondary to the central line being pulled out. As cardiac says put them in trendelenburg and on the left side. Put 100% o2 on...pt may need to be intubated.
  8. by   dfk
    Quote from swaymaiway
    Hi! Need some assistance here...How do you position a patient 24hrs post-op whose CVP line was accidentally disconnected. Patient is in respi distress and hypotensive. Please help!
    well, cvp is venous, so 1 hour or 24 hours post-op really isn't the problem per se.. think of clot and movement.. or positioning of the catheter.. especially if there is a "kink" and not enough blood flow.. distress can occure because of lack of blood flow.. on the former note, clavian arch to right atrium/ventricle will travel to the lungs.. my guess could also be pulmonary emboli.. of course, it's difficult to determine, given the VERY little info received from you... but, insertion might have been a problem as well.. however, again, resp. distress, to me, signals a difficulty somewhere, not a volume issue.. i would be interested to know what the "outcome" and "cause" were...
    thanks for the provocation of thought !
    Last edit by dfk on Aug 30, '06
  9. by   dfk
    sorry, but to add to this, trendelenburg position has been in literature, "proven" not to be effective, and perhaps more detrimental to the pt.. "they" say that mild trendelenberg would be more beneficial (legs up torso flat)... you want to maintain the most productive flow possible, and horizontal has the least resistance at this time..
  10. by   dfk
    Quote from swaymaiway
    There was no further info given....it was given as a question as to how should a nurse position a patient who is hypotensive and with respiratory distress whose CVP Line was accidentally disconnected. for one, i know that patients with CVP are not supposed to be positioned head raised/elevated...am i right?
    actually, there is no contra-indication for those with a cvp regarding positioning, unless (severe) head injury, severe hypotension, blahh blahh... cvp 'merely' measures right atrium pressures, but also gives total body volume estimate.. at my most recent facility, docs were reading cvp more for fluid status than swan, which, in many places, rather states, cities, countries, is becoming less the standard for fluid status, save for the immediate and unexpected post-op, which, i'm sure, is more common than we see, nor perhaps want. of course, how thick of a line is that determinant? i guess that's why we're here...
  11. by   TopherSRN
    The whole poitn of the question is there is an air emobolus (secondary to an open CVP port) and how you position them if they have a suspected air embolus. Cardiac and mclean gave the correct answer. Everything that follows is drivel and nothing more.
  12. by   swaymaiway
    Many thanks everyone for participating in enligtening me with your answers! It is highly appreciated! :blushkiss
  13. by   dfk
    Quote from TopherSRN
    Everything that follows is drivel and nothing more.
    actually, yes, you are 100% correct.. i should have left the beer in the refridgerator before posting that night..
    oh well, to the OP, i apologize for taking up space that day.
  14. by   tde1992
    This person said that when a person has a CVP their head of bed can't be elevated. I have never heard of that, I am going to try to find literature regarding this. I work in a medical intesive care unit, where we monitor CVP all the time via central lines, and swans, but I have never heard of any contrandications with finding the values with the head of bed raised. I do know that the actual values should be read during expiration due to the increased intrathoracic pressure which increases the readings. Can anyone comment on the head of bed issue and monitor of CVP. Thanks

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