what's going on ladies and gentlemen it's your boy nurse bass back with another video and in today's video guys i have another educational installment for you and what we're going to discuss in today's video is something called central venous pressure also known as c v p without further ado let's dive in are you listening [Music] so what the heck is central venous pressure right what are we talking about whenever we talk about central venous pressure so i'd like for you guys to imagine that what we have here is the heart and you guys will recall right that our heart is broken up into four chambers right two atria up top and two ventricles on the bottom and we'll remember anatomically this is the left side of the heart and this is the right side of the heart and so what we have right coming off of the bottom and the top on the right side of our heart we have our superior and our inferior vena cava they end up feeding blood down into our right atrium to the right side of our heart right this is all of our deoxygenated blood returning from the upper and lower portions of our body via our superior and inferior vena cava being fed back into the right side of our heart deoxygenated blood to then be pumped out up into the pulmonary vasculature to be re-oxygenated okay we got that so central venous pressure is simply a measurement of the pressure right here at this cavo atrial junction right cavo atrial junction the junction in which our superior slash inferior vena cava meet our atrium right so what we have is a cavo atrial pressure and so what is this right what are we talking about this is a volume of blood a volume of fluid that is actually being exerted on the walls of this superior inferior vena cava right it's a volume of fluid within our vessel that's exerting pressure on our walls and this is what we call our cvp this is our central venous pressure think about our superior and inferior vena cava being our central vein much like our aorta which comes off of our heart is basically our central artery right carrying oxygenated blood think about our superior and inferior vena cavas as being our central veins so what we have is a central venous pressure and so this pressure that's being applied on this vessel the cvp the normal reference range is two to six millimeters of mercury okay that's our normal reference range and so let's think about this for a second all of the fluid that's returning back to the right side of our heart via our superior inferior vena cava all gets deposited through this cavo atrial junction down into the right atrium that's our central venous pressure and the normal reference range is two to six so we could also think about our cvp this numerical value as being reflective of our pre-load right all of the fluid that's returning back to our heart that's going to eventually fill up our ventricles and then be ejected out of the heart that's our preload right they talk about preload being defined as the amount of actual stretch that's being applied on that myocardium the amount of stretch as more volume gets put into that ventricle the more that myocardium stretches they refer to it as the amount of stretch but another way i think about preload is simply the amount of volume that is in that ventricle right before it ejects right before systole so central venous pressure the amount of volume of blood applying a pressure on our veins fluid returning back to the right side of the heart this cvp can also be reflective of uh preload and so we think right whenever we're discussing cvp a normal reference range being two to six what is occurring if we have a cvp greater than six right what if what if we have in that vena cava right that's feeding into the right side of the heart what if in that vena cava we have a much higher cvp right a much larger amount of volume pushing on those vessels creating a larger pressure a larger cvp cvp greater than six this patient is in fluid overload right a few different things actually that could cause and increase cvp but let's think about our patient being a fluid overload inside of that heart inside of our vasculature we have too much volume let's think about an instance such as chf congestive heart failure patients are not able to adequately eject blood out of the heart fluid then backs up patients become fluid overloaded we start to see third spacing of fluids such as pitting edema things of that nature too much pressure in our veins too much too high of a cvp too much pressure this is usually in instances where patients are fluid overloaded how might we treat somebody who has too high of a cvp they are volume overloaded they have too much pressure right here at this cabo atrial junction well this is instances where we may see things such as diuretics right we see this all the time in the cv icu we usually are used to using advanced invasive hemodynamic monitoring such as a cvp we're always measuring volume statuses of our patients in the icu as we're constantly giving them a lot of fluid a lot of iv drips medications volume right a lot of volume so as we're giving them a lot of volume we want to make sure we keep an eye on their cvp status cbp is getting too high we may see things such as furosemide pushes or furosemide drips the entire idea being as we administer this diuretic it's going to cause a patient to pee more volume off therefore reducing our cvp and so what if instead on the other hand we actually had a low cbp right maybe a cvp less than two let's say here at this cable atrial junction where we're measuring cvp we have a low amount of blood a low amount of volume exerting an incredibly weak amount of pressure on our superior and inferior vena cava right a low cvp we're volume depleted this could be in instances such as hemorrhagic shock for instance a patient has sustained maybe a gi bleed right if a patient has a gi bleed they're bleeding into their gi tract they're losing intravascular volume so what's going to occur as a result as you deplete the intravascular space that space within the vessels a volume you're going to reduce your cvp you're going to reduce the amount of blood that is then able to return back up to the right side of the heart via the superior and inferior vena cava also tying in that idea of preload as we have this hemorrhagic shock and we have less volume returning to the right side of the heart think about it as us having lower preload right this is these are all intertwining advanced hemodynamic concepts but i just wanted to try and tie that in a little bit better for you so low cvp due to blood loss cvup less than two low pressure at that cavo-atrial junction therefore decreased preload how are we going to treat patients who don't have a lot of volume returning back to the right side of their heart who are losing volume we're going to give volume right we're going to give a volume this could be in instances you know such as actual fluids iv solutions could also be in the form of blood could be albumin which is basically a plasma protein that we give intravenously the entire idea being that when we give albumin it's going to pull fluid from our interstitial tissues back into our vessels to increase the total amount of volume that we have in those vessels plump them up right fatten those vessels up we're depleted our vessels are collapsed our preload is in the can our cvp is less than two we're volume depleted let's give volume let's give crystalloids let's give albumin we need to increase the cvp and so guys that was central venous pressure in a nutshell right remember that what are we talking about we're talking about that central vein that superior and inferior vena cava it's a measurement of the pressure in that cavo atrial junction pressure being applied on that vein wall by fluid so it is a measurement of our fluid status it is a measurement of our preload it is a good indicator as far as what our volume status looks like cvp normal of two to six cvp greater than six where volume overloaded our volume status is too high we need to diary some of that extra volume off or if our cvp is less than two and our volume status is too low too little pressure being applied on that central vein too little venous pressure we need to give volume we need to expand those vessels guys that was cvp and i really hope that this quick down and dirty help makes more sense of the concept of cvp this advanced hemodynamic measurement that we use in critical care to assess patients fluid status if you're new to the channel be sure to hit that subscribe button down below we're putting out content every week to motivate uplift and inspire you to be the best damn nurse you can be share this with a friend if you think it would help them and i hope that you guys have a great day [Music]