Central Venous Pressure (CVP)

Central Venous Pressure (CVP)

David Ray Velez, MD

Definition

  • Pressure within the Central Venous System (SVC or Right Atrium)
  • Represents the Driving Filling Force of the Right Heart

Measurement

  • Measured by Attaching a Pressure Transducer to a Central Venous Catheter (CVC/Central Line)
  • Measured at End-Expiration – When Intrathoracic Pressure Equals Atmospheric Pressure
  • Normal Values: 2-8 mmHg

Central Venous Pressure (CVP) Waveform

  • A Wave: Atrial Contraction (End Diastole)
  • C Wave: Tricuspid Closure (Early Systole)
    • “Isovolumetric” Contraction
  • X Descent: Atrial Relaxation (Mid Systole)
  • V Wave: Ventricular Contraction Causing Systolic Filling of Atrium (End Systole)
  • Y Descent: Early Ventricular Filling (Early Diastole)

CVP Waveform

Clinical Use

  • Generally Discussed in the Context of Fluid Responsiveness
  • Single Targeted Values Have Limited Clinical Use
  • May Be a Better Indicator of “Preload” and Not Necessarily “Preload Responsiveness”
  • Extreme Values May Be More Reliable (< 6 Indicates Fluid Responsive and > 15 Indicates Not)
  • *See Fluid Responsiveness

Waveform Analysis

*Image Source: Bootsma IT, Boerma EC, de Lange F, et al. The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis. J Clin Monit Comput 36, 5–15 (2022). (License: CC BY-4.0)