CVP's before x-ray line confirmation

detroitdano · Oct 19, 2009

I think you'd have been fine to just flush a little saline into it. You weren't giving hardcore meds, and it wasn't some crazy tonicity solution that required the line be confirmed centrally placed. If the number would have helped them dose meds or order something, then I would have gone ahead and done it. Gotta remember your basic benefits/risk thinking.

RedCell · Oct 19, 2009

Am I just overparanoid since the amount of fluid running from the pressure bag would be minimal and x-ray was (supposedly) on the way?.

Sort of....Assuming the cordis was not placed in the left IJ (possible thoracic duct injury), as long as you have nonpulsatile blood return life is good. I place at least two or three central lines a week and never get films prior to using them. As long as manometry proves to be venous I am happy.

TakeBack · Oct 20, 2009

This depends in part on the line insertion technique. If you are getting brisk blood return w/ syringe, then you're either in the IJ/right heart or the carotid. Pressure tubing manometry or looking at the pulsation are reliable cues as to where you are.

If they used an US to insert it the odds of correct placement are even higher.

I have put in innumerable lines as well and when I swan I don't wait for XRay- insert cordis and float SGC all in the same setting. Trust your technique and pressure reading and you're good. You can transduce a pressure at the time of insertion to tell you if you're arterial or not.

If all these indicators are good for correct placement, I would float the swan and shoot some numbers.

the CXR is primarily for the PTX r/o and to make sure the swan is in the right place.

meandragonbrett · Oct 20, 2009

I have no problem hooking up a transducer to a line before x-ray is shot/read.

detroitdano · Oct 20, 2009

It's funny you mentioned this because I had this scenario last night at work after replying. Doc placed the line then asked if we could get a CVP since I was bolusing her among other things. I said it wasn't confirmed yet, he said "Oh." I asked a seasoned nurse and she said it's up to me. I waited, because we weren't making any huge decisions based on the CVP at that exact moment. It was a fair call as her CVP was fine once the line was confirmed.

dorimar, BSN, RN · Oct 23, 2009

Uhm,

When we swan patients, we transduce and monitor the waveform the whole way... No Xray untill the end--after the monitoring. We are talking about the minute amount it takes to monitor, not infuse...

criticalHP, MSN, RN · Oct 23, 2009

I would hook it up to get a CVP reading if the doc needs it to expidite tx, but if it can wait for confirmation then that's ok too. It really depends on the patients status, why it is needed, and if the doc plans on acting on the data obtained.

SG should be monitored as it is inserted. If you see the expected progressive waveforms and associated readings (CVP-RV-PA-PAW) then you KNOW where itis--but it still may be required to get the film to ID problems with the insertion.

criticalHP, MSN, RN · Oct 23, 2009

Post thought--when we put in the cordis the doc would call for the flush to run until cleared. This amounted to about 20ml or so. Most of the time the doc would eyeball the CVP as the cordis was inserted by measuring height of the blood in the cordis.

richard1980 · Oct 26, 2009

Yesterday surgery placed a cortis in my pt with the hopes of getting CVP's (followed by a swan if needed). I have allways been told under no circumstances to hook anything up to a line such as this without x-ray confirmation. Allthough the pt wasn't crashing (yet...) they wanted these readings sooner rather than later. He told me to hook it up and get the reading and I respectfully declined, and got a pretty dirty looks for the surgeon. Am I just overparanoid since the amount of fluid running from the pressure bag would be minimal and x-ray was (supposedly) on the way? I am still a young pup in the ICU (barely over a year) so any thoughts would be welcome.

You'd be fine to hook up the pressure line. The doc will flush it with a hell of a lot more than the mL of 0.9 you'll be giving the patient by hooking up their line. You'll be able to tell right away if you're in the right spot by the waveform.

RN1982 · Oct 27, 2009

I always transduce a CVP after placement without an x-ray. I've never been told that it was wrong.

PICC ACE · Oct 27, 2009

Agree with all the above postings on attaching a transducer--no problem at all to do so. Furthermore,it is also our practice to draw labs from a line that has yet to be x-rayed. Just no infusion of meds until placement is confirmed.

Z.