When you do your critical care clinical rotation, you will most likely be monitoring your patient’s CVP (central venous pressure). We’ll get into the what’s and why’s of CVPs in another post…for this post we’re going to talk about the basics of setting up the CVP line. With any luck you’ll get an opportunity to practice, so this should give you a wee bit of a head start. Note that I always say there is more than one way to skin a cat….if your preceptor sets up the lines differently, that is great…you’ll learn multiple ways and ultimately figure out the one that works best for you. Ok, let’s get going!
The first thing you’ll want to do is get your supplies. In the ICU where I work these are called “Sorensen Kits” but maybe that’s just what we call them. The kit includes a 500ml NS, a pressure bag (though not really a bag itself…it wraps around your bag to create pressure), a transducer and a mount so you can attach the transducer to your IV pole.
Here’s what our kits look like (except for the pressure bag)
Open your transducer packaging and check all the connections. You don’t want to go through all the trouble of setting up your line, only to lose sterility when a piece falls onto the floor. So, check all connections first!
Next, clamp your IV line so that when you spike your bag, you don’t get a bunch of air as things run willy-nilly through your pressure system.
Next, you will spike your IV bag and mount it inside your pressure device, like so:
Now this is when the big controversy starts. Some people swear by flushing your line without any added pressure, but I have found that I need at least some pressure in order to get the NS to run all the way through the line. Feel free to try it both ways and do what works best for you. So for me, my next step is to pressurize my bag.
You’ll notice that even though you pumped your pressure up to 200-300, removed the cap on the line, and unclamped your roller, nothing much is happening. That’s because there’s a little dohicky of some kind on the system that keeps it more or less closed. On our systems, that little dohicky is a blue “pigtail.” Make sure the open end of your pressure line is aiming into some kind of receptacle (I always use the bag the transducer kit comes in) and pull on that little pigtail. Voila! The NS should now flow through your line. Yay!
The next thing you’ll notice is that your syringe is filling up with NS…fill that baby up! I didn’t take a picture of this part (sorry!) but you’ll get your syringe nice and full, then flush that NS through the remainder of the line. Look throughout your line for any bubbles. If you spot any, just flush some more by pulling on your pigtail. Once your line is clear of all air bubbles, you’re almost there!
The next thing you want to do is replace the cap on the transducer with what’s called a “dead-ender.” The cap on the transducer actually has a little opening…you need this to be a closed system, so check out that cute little bag of extra caps in your transducer kit. See the blue one? That’s the one you want. Before you put the blue cap on, turn the stopcock on the transducer so that you are OPEN to the white cap it came with…pull your pigtail and you’ll see NS squirt out through the opening on that cap. Cool, huh?
Once that little tiny length of plastic is primed, take off the white open-ended cap and replace with a blue “dead-ender.” Like so:
Now, all that’s left is to actually attach your setup to your patient. You’ll want to use a central line for this (obviously, that’s why it’s called CENTRAL venous pressure monitoring…haha). While you can technically use a PICC line for it, the PICC itself is so long it produces its own pressure, so I find I get the best and most reliable readings from a central line placed in the IJ.
Hang your pressurized bag on an IV pole, and attach your mounting device to the pole. Next, mount your transducer to the mounting device (was that redundant?) and connect your pressure line to your central line. Make sure the port on your central line doesn’t have any kind of valve device added to it…just screw the pressure line straight into the central line.
Now you’ll get out your trusty level and level the transducer to the phlebostatic axis…which is here:
Next, you’ll zero your system (which may be completely different depending on what kind of monitor you use, so I won’t go into that here) and you will see your CVP tracing on the monitor. Cool huh?
So those are the basics for setting up your CVP line…give it a few practices and you’ll be setting up your lines like a pro in no time!
Be safe out there!