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1. Question
The nurse is checking the client’s central venous pressure. The nurse should place the zero of the manometer at the:
Correct
Answer A is correct.
Rationale: The phlebostatic axis is located at the fifth intercostals space midaxillary line and is the correct placement of the manometer. The PMI or point of maximal impulse is located at the fifth intercostals space midclavicular line, so answer B is incorrect. Erb’s point is the point at which you can hear the valves close simultaneously, making answer C incorrect. The Tail of Spence (the upper outer quadrant of the breast) is the area where most breast cancers are located and has nothing to do with placement of a manometer; thus, answer D is incorrect.
Incorrect
Answer A is correct.
Rationale: The phlebostatic axis is located at the fifth intercostals space midaxillary line and is the correct placement of the manometer. The PMI or point of maximal impulse is located at the fifth intercostals space midclavicular line, so answer B is incorrect. Erb’s point is the point at which you can hear the valves close simultaneously, making answer C incorrect. The Tail of Spence (the upper outer quadrant of the breast) is the area where most breast cancers are located and has nothing to do with placement of a manometer; thus, answer D is incorrect.
Central Venous Pressure
Monitoring The CVP, the pressure in the vena cava or right atrium, is used to assess right ventricular function and venous blood return to the right side of the heart. The CVP can be continuously measured by connecting either a catheter positioned in the vena cava or the proximal port of a pulmonary artery catheter to a pressure monitoring system.
Blood from systemic veins flows into the right atrium; the pressure in the right atrium is the central venous pressure (CVP). CVP is determined by the function of the right heart and the pressure of venous blood in the vena cava. In normal health the amount of blood coming to the heart is balanced precisely by the amount of blood leaving the heart. When there is blood loss or other alteration in the cardiovascular system’s homeostatic mechanism it will first be reflected in changes of the venous pressure at this point. As a rule of thumb the central venous pressure is a good indicator of the amount of blood returning to the heart from the systemic circulation. Further, it (CVP) is a good indicator of the pumping ability of the right atrium and the right ventricle. When the right atrium or ventricle is failing (e.g. following right atrial or ventricular MI) the CVP will be one of the first indicators to rise. The rising CVP indicates that the atria and/or ventricle are failing.
The pulmonary artery catheter, described in greater detail later, is used for critically ill patients. Patients in general medical-surgical units who require CVP monitoring may have a single-lumen or multilumen catheter placed into the superior vena cava. Intermittent measurement of the CVP can then be obtained with the use of a water manometer.
