normal CVP

Pediatric Critical Care Columnist · Oct 16, 2006

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.

RaggedyRN · Oct 21, 2006

Higher cvp = fluid overload and lower cvp = dehydration??? CVP's are new to me. Thanks!

Pediatric Critical Care Columnist · Oct 21, 2006

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?

RaggedyRN · Oct 23, 2006

Yes that does make sense. I had a 4 month old admitted with pulmonary hemorrhage. He was immediately put on HFOV, US head done, no bleed. Pt. presents with anasarca with a CVP ranging from 13 - 15. His line is in his left Fem. Excellent learning experience for me too see this. Thanks for clearing this up and helping to make some things click! 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. Unfortunately this child had a poor historian, and no family present or accounted for. Thus far he is a ward of the state and social work will hopefully be able to get more details for us about the patients past medical history or patient will improve enough to do more diagnostics.

Thanks again :thankya:

Pediatric Critical Care Columnist · Oct 23, 2006

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!