normal CVP

Yes it is. Normal is 5-10 mmHg. In most patients it reflects fluid volume status, but in cardiac kiddies it indicates right ventricular function.

True, to a point. If the child has a cardiac defect, then there are other things that a change in CVP might reflect. This depends on where the line is... femoral lines are only really good for trending. Lines placed above the clavicles measure pressures just upstream from the right atrium and give a reflection of right-sided heart function. Higher CVP in the cardiac patient may mean simple fluid overload, but it could mean worsening right heart failure. The atrium is trying to empty into a stiff or dilated right ventricle and can't, so the pressure rises. In kids who come from the CV-OR with higher-than-normal CVP and are kept euvolemic, a drop may indicate gradually improving function. Make sense?

I was looking forward to some days off but am anxious to see if he will be weaned from HFOV and what the whole picture will look like.

Thanks again :thankya:

Gee, you sound just like me!!

This patient has a lot of reasons for elevated CVP. Pulmonary hemorrhage will cause stiff lungs and high pulmonary artery pressures, thus impaired right ventricular emptying. Contributing cause #1. Anasarca... massive pitting edema in every interstitial space. Contributing cause #2. HFOV is a big one. It totally changes the pressure dynamic in the thorax and abdomen and impairs venous return. Contributing cause #3. Another thing that may come into the picture is abdominal compartment syndrome, where the lungs take up so much space that the diaphragm is pushed down and the viscera are compressed, become edematous trying to protect themselves and make things worse. Interesting case, excellent learning opportunity. Keep asking questions, it's the best way to learn!