The nurse is checking the client’s central venous pressure. The nurse should place the zero of the manometer at the:
A. Phlebostatic axis
B. PMI
C. Erb’s point
D. Tail of Spence
Correct Answer: A. Phlebostatic axis
The phlebostatic axis is located at the fifth intercostal space midaxillary line and is the correct placement of the manometer. Phlebostatic axis is a point located by drawing an imaginary line from the fourth intercostal space at the sternum and finding its intersection with an imaginary line drawn down the center of the chest below the axillae.
Option B: The PMI or point of maximal impulse is located at the fifth intercostal space midclavicular line. The point of maximal impulse, known as PMI, is the location at which the cardiac impulse can be best palpated on the chest wall. Frequently, this is at the fifth intercostal space at the midclavicular line. When dilated cardiomyopathy is present, this can be shifted laterally.
Option C: Erb’s point is the point at which you can hear the valves close simultaneously. “Erb’s point” is also a term used in head and neck surgery to describe the point on the posterior border of the sternocleidomastoid muscle where the four superficial branches of the cervical plexus—the greater auricular, lesser occipital, transverse cervical, and supraclavicular nerves—emerge from behind the muscle.
Option D: The Tail of Spence (the upper outer quadrant) is the area where most breast cancers are located and has nothing to do with the placement of a manometer. The tail of Spence (Spence’s tail, axillary process, axillary tail) is an extension of the tissue of the breast that extends into the axilla. It is actually an extension of the upper lateral quadrant of the breast. It passes into the axilla through an opening in the deep fascia called foramen of Langer.