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Hello Whatnext:
Gee, I would have to agree with you.
Right atrial pressure (RAP) is measured at the proximal port of the pulmonary artery catheter (which is located in the right atrium) hense calling it the RA or RAP. Atrial pressures are commonly used to evaluate pre-load, because, as you stated, atrial pressure correlates to the end-diastolic pressure for the respective ventricle.
May I quote from Robin Donohoe Dennison Pass CCRN third edition, 2007, p.68: "Right ventricular end-diastolic pressure and preload are evaluated by right atrial pressure"
Maybe it is a case of "you say tomato and I say tomahtoe"...?
Dunno....I guess as long as it doesn't affect patient care....."when in Rome..."
Just as long as everyone agrees on the normal values of RA v. CVP.
athena
I figured it was just a preference, or whether one is taught using RAP vs CVP. This particular nurse was adamant that it was RAP and that to call it CVP was wrong, although the values for CVP and RAP are the same. Maybe she would use CVP if the tip of a catheter (central line, etc) was not truly in the right atrium, but the vena cava (of course, the literature I've read says it is essentially the same). I just wanted to make sure there is not something I am missing (I came from a surgical trauma ICU and am now in CICU), but I did not want to go round and round arguing about such a thing with this nurse when we agreed on the normal values.
Before there were monitors that would give a digital display you used a glass tube connected inline to the venous catheter. A CVP manometer would measure in centimeters how high the water in the tube would be above the right atrium. With the advent of monitors with transducers this is no longer used. The problem is CVP measures with water and monitors are measuring with millimeters of mercury so 1.34 cms of water equals 1 mm of mercury.
Before there were monitors that would give a digital display you used a glass tube connected inline to the venous catheter. A CVP manometer would measure in centimeters how high the water in the tube would be above the right atrium. With the advent of monitors with transducers this is no longer used. The problem is CVP measures with water and monitors are measuring with millimeters of mercury so 1.34 cms of water equals 1 mm of mercury.
Chisca:
Oh my goodness, I thought I was the only one that remembered that! Remember calculating the CVP measurments? So I guess you should remember glass syringes and remember the "drum catherter" usually inserted in the brachial? Or when arterial transducers first came about, nothing was disposible, used metal transducers and you had to put a drop of saline on the membrane...or how about how you had to check for the barometric pressure before analyzing an ABG? Or glass bottle system for chest tubes?
Ahhh the "good" ol' days, so glad they are gone! (Well, sometimes....)
athena
I was always taught that the RA MEAN = CVP. The RA pressure has a systolic and diastolic waveform just like any other hemodynamic measure. Do some running totals next time you have a Swan. Write down your RA mean and see if it doesn't correlate with the CVP. Your PA diastolic should also correlate with your PA wedge pressure.
Just my
whatnext
75 Posts
I've always heard CVP referring to RA pressures, including the research I've read. I just recently moved and when I called the RA a CVP (talking about the proximal port of a PA catheter) I was corrected and told it is an RA, NOT CVP since the reading is coming from the right atrium. The research I've read refers to the CVP when referencing this waveform, as we are actually estimating the right ventricular end diastolic pressure.
Can anyone provide any input as to the difference between RA and CVP?