To support Jeffrey’s point;
The critics of CVP always leave off that second word “Waveform”. Central Venous Pressure is an incredible fluctuation of pressures within every cardiac cycle to maintain the SVC as point of lowest blood pressure within the body. It has to be lowest so that arterial blood goes brain first as path of least resistance back to the heart with every cardiac cycle even when we’re upside down. Lifting the legs and watching the patient’s stroke volume go up while CVP appears to remain constant is proof. The CVP waveform on the other hand showing exactly what went on to keep the patient from passing (red) out when the legs were lifted. Simply connect a transducer to the central line to start obtaining this waveform. The debate over the usefulness of CVP can then begin about what part of the waveform is being discussed. No accurate data is bad data. CVP = The weight of the horse = 1,500 lbs CVP Waveform = The impact force of each hoof as it hits the ground, how far apart, and how often as a 1,500 lb horse transitions between a trot, canter and gallop. Fluid Bolus = The jockey A useful PowerPoint of what’s in a CVP Waveform is in the link below. <http://www.uth.tmc.edu/anes/Assets/powerpoint/CVP-and-Arterial-Monitoring.pps> CVP and Arterial Monitoring www.uth.tmc.edu Matt Reavill Plainfield, IL From: [email protected] [mailto:[email protected]] On Behalf Of Jeffrey R Hanlon RN Sent: Saturday, February 16, 2013 10:15 AM To: [email protected]; [email protected] Subject: Re: [Sepsis Groups] Fwd: volume required CVP may not be the best measurement but it is tool in the arsenal. Not everyone has the arterial line monitoring that is available to look at SVV, SV, CO/CI but this is a useful tool in place of the Swan that I haven't actually seen used in many years. Most younger ICU nurses I have spoken with have never been taught to set one up let alone use them to monitor hemodynamics. Technology has come a long way. If you are looking for information please feel free to contact me offline Jeffrey R Hanlon RN Stamp Out Sepsis <http://www.world-sepsis-day.org/WSD/en?sid=u5iqdrmsatL1SZb01Ehxkw&iid=2> World Sepsis Day Logo -----Original Message----- From: Andy Bourgeois <[email protected]> To: sepsisgroups <[email protected]> Sent: Fri, Feb 15, 2013 10:19 am Subject: [Sepsis Groups] Fwd: volume required There is a good recent review on various methods to measure cardiac output to assess fluid responsiveness: Marik, PE. Noninvasive Cardiac Output Monitors: A State-of the-Art Review. J Cardiothorac Vasc Anesth. 2013 Feb;27(1):121-34. http://www.jcvaonline.com/article/S1053-0770%2812%2900148-6/fulltext There is also good evidence that CVP does not predict fluid responsiveness well: Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8 http://journal.publications.chestnet.org/article.aspx?articleid=1085950 -Andy Andy Bourgeois, MD, FAAEM Simi Valley Hospital On Tue, Feb 12, 2013 at 6:17 AM, [email protected] <[email protected]> wrote: > > Fluid challenge is one of the most dificult things to do....sometimes you > just need 1 l of cristaloids on others you will use as much as 5 l.....as it > was mentioned above the clinical response is the goal....o others you will > need more tools like central venous pressure, svo2 > Even measure the diameter of inferior cava vein all these to estimate where > are you standing..... > Hope it helps > Juan pataro md > instituto argentino de riñon y transplante > > From my HTC Sensation 4G on T-Mobile. The first nationwide 4G network > > > ----- Reply message ----- > De: "Rich Levrault" <[email protected]> > Para: "sandeep varma" <[email protected]> > CC: "[email protected]" > <[email protected]> > Asunto: [Sepsis Groups] volume required > Fecha: dom., feb. 10, 2013 10:59 a. m. > > > Fluid should be given until it fails to produce a clinically appropriate > response. Pulmonary edema is sometimes a necessary evil. > > Sent from Rich's iPhone > > On Feb 9, 2013, at 1:15 AM, sandeep varma <[email protected]> wrote: > > hello all > i have a query regarding fluid volume requirement in sepsis. often have seen > blood pressure improvement after fluid bolus but only to see it fall back > after few minutes. the postulated theory behind this was leakage of given > fluid into interstitial causing intravascular depletion again. my concern is > that how much of fluid can be given this way? will this lead on to pulmonary > edema and interstitial edema without much helping in building up intra > vascular volume and aiding in stabilizing blood pressure? > sandeep varma > thriuvananthapuram > kerala > india > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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