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Central venous pressure (CVP), also known as mean venous pressure (MVP) is the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. CVP is often a good approximation of right atrial pressure (RAP),[1] however the two terms are not identical, as right atrial pressure is the pressure in the right atrium. CVP and RAP can differ when arterial tone is altered. This can be graphically depicted as changes in the slope of the venous return plotted against right atrial pressure (where central venous pressure increases, but right atrial pressure stays the same; VR = CVP-RAP).
CVP has been, and often still is, used as a surrogate for preload, and changes in CVP in response to infusions of intravenous fluid have been used to predict volume-responsiveness (i.e. whether more fluid will improve cardiac output). However, there is increasing evidence that CVP, whether as an absolute value or in terms of changes in response to fluid, does not correlate with ventricular volume (i.e. preload) or volume-responsiveness, and so should not be used to guide intravenous fluid therapy.[2][3] Nevertheless, CVP monitoring is a useful tool to guide hemodynamic therapy. The cardiopulmonary baroreflex responds to an increase in CVP by decreasing total peripheral resistance while increasing HR and ventricular contractility in dogs.[4]
Pulmonary capillary wedge pressure
Normal CVP can be measured from two points of reference:
CVP can be measured by connecting the patient's central venous catheter to a special infusion set which is connected to a small diameter water column. If the water column is calibrated properly the height of the column indicates the CVP.
In most intensive care units, facilities are available to measure CVP continuously.
Normal values vary between 5 and 10 cmH20 [6]
Factors that increase CVP include:
Factors that decrease CVP include:
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