Central venous pressure (CVP) is the blood pressure in the venae cavae, 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 back into the arterial system. CVP is often a good approximation of right atrial pressure (RAP),[1] although the two terms are not identical, as a pressure differential can sometimes exist between the venae cavae and 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 systemic vascular resistance while increasing heart rate and ventricular contractility in dogs.[4]
Trend of central venous pressure as a consequence of variations in cardiac output. The three functions indicate the trend in physiological conditions (in the centre), in those of decreased preload (e.g. in hemorrhage, bottom curve) and in those of increased preload (e.g. following transfusion, top curve).
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.[citation needed]
^Table 30-1 in: Goers TA, Klingensmith ME, Chen LE, Glasgow SC (2008). The Washington Manual of Surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN978-0-7817-7447-5.