Information Derived from Analysis of the CVP Waveform

Created on Mon, 07/13/2015 - 00:22
Last updated on Tue, 08/11/2015 - 21:46

This issue was vaguely touched upon in Question 14 from the first paper of 2001, "What are the determinants of central venous pressure? How may its measurement guide patient management?"

Nobody has thus far asked about the waveforms per se, but they are mentioned as a part of answering the question of "what use is the CVP?"

Information from amplitude

  • Right atrial pressure; which is elevated in the following settings:
    • Right heart failure
    • Congestive heart failure
    • Massive PE
    • Cardiac tamponade
    • High PEEP

Information from waveform

  • Atrial rhythm
  • Atrial capture in response to pacing
  • Presence of atrial activity in SVT (i.e. "is it just a rapid AF?")
  • Characteristic waveforms are seen in the following settings:
    • AF: absent a waves
    • Juctional rhythm, VT, complete heart block: cannon fused ac waves
    • Tricuspid regurgitation: fused cv waves
    • Triciuspid stenosis: prominent a wave
    • Pericardial constriction or poor RV compliance: bifid CVP wave
    • Cardiac tamponade: prolonged y descent

 

References

Most of this material can be found in Bersten and Soni’s” Oh's Intensive Care Manual”, 6th Edition, as well as the CVC section from The ICU Book by Paul L Merino (3rd edition, 2007)

Additionally, I have made use of the amazing Essentials of Critical Care, 8th ed.(ch.3 - Monitoring in the ICU).

For those willing to pay for it, there is a good UpToDate article on this.

For those unwilling to pay, see these free articles:

Magder, S. "More respect for the CVP." Intensive care medicine 24.7 (1998): 651-653.

Pittman, James AL, John Sum Ping, and Jonathan B. Mark. "Arterial and central venous pressure monitoring." International anesthesiology clinics 42.1 (2004): 13-30.

Marik, Paul E., and Rodrigo Cavallazzi. "Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense*." Critical care medicine 41.7 (2013): 1774-1781.

Alzeer A et al. Central venous pressure from common iliac vein reflects right atrial pressure. Can J Anaesth 1998 Aug 45 798-801.

Magder, Sheldon. "Central venous pressure: A useful but not so simple measurement." Critical care medicine 34.8 (2006): 2224-2227.