iv management from 3m

8/11/2019 IV Management From 3M

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3M Critical & Chronic Care Solutions

3M2009. All

Tromboplebitis

2) Mekanik: Extravasasi

Komplikasi pemasangan Infus1) Inflamasi: Plebitis


Uji Kompetensi Perawat

Memeriksa tanda-tanda vital Menggunakanteknik antiseptik

Evaluasi respon terhadapmedikasi

Panduan Latihan Uji Kompetensi Perawat, 2012

Menggunakan prinsip standard precaution Memasang, merawat dan melepas infus


Apakah Plebitis?Bila insersi infus mengalami:..

Sakit Merah Bengkak

3M Critical & Chronic Care SolutionsFaktor Penyebab Plebitis

Osmolaritas; Kadar pH: 7-7,4

Fiksasi Kateter

Hand hygiene Skin Preparation Perawatan lukatusuk:

Transparan dressingbisamencegah plebitis

Chemical

Mechanical

Micro biological


Infusion Procedure

Persiapan Insersi Perawatan


RL ? Aminoleban ?Rujukan

DX 10% ? Aminovel 600 ? L : < 450M : 450 - 600

H : > 600pH : 7-7.4DX5% +NaCl0.9% ? Amiparen ?

INS (Infusion Nursing Society)

Chemical

280 768

555

585


3/8


Domino Effect; Fiksasi yg tdk optimal

Pain, Needle Stick Injury, Cost

Suboptimal Securement

Increased Catheter Movement

Phlebitis, Thrombosis, Dislodgement, Infection

Catheter Restart

Schears G. 3M G lobal IV Leadership Summit, 2011.


Teknik Antiseptik; Skin PreparationBagaimana Tekniknya? The frictional back & forth & circle

clean the skin & antiseptic penetrate the skinlayers.

Mikroorganisme Residen 1 mm depth epidermis: 25 layers.

The first 5 of epidermis layers residedby 80% resident MO.

Antiseptik Recommend CHG have persistent activity

Dont use antimicrobial ointment.

American Association of Blood Banks for donor site preparation.

3M Critical & Chronic Care SolutionsMekanisme Kontaminasi MO

.


Pemilihan IV dressing

Secure/Fiksasi + + + +

Protect/Melindungi - - + +

Monitor/Observasi - - + +

Replacement/Penggantian 2 Hari 2 Hari 72 Jam 7 Hari

Parameter

Kasa + Plester Non Woven Transparan TransparanCVC

Jenis


Untuk Memudahkan monitoringLuka tusuk infus Untukmengantisipasi terjadinya plebitis


INS Visual Infusion Phlebitis (V.I.P.) Score ; 2011IV site appears healthyNo pain at IV site, no erythema,No swellingNo palpable venous cord (all ages)

0 No signs of phlebitisOBSERVE CANNULA

Erythema at access site With or without pain 1

Stop infusion if possible Identify additional resources

for management Remove IV if symptoms persist

Erythema Pain at access site With or without edema

2 Stop infusion if possible Identify additional resources

for management Remove IV if symptoms persist

Erythema Pain at access site With or without edema Streak formation Palpable venous cord

3 Stop infusion if possible Identify additional resourcesfor management

Remove IV Notify primary service

Erythema Pain at access site With or without edema Streak formation Palpable venous cord > 1 inch Purulent drainage

4 Stop infusion and establish alternateIV site

Remove IV and culture site and cathetertip

Notify primary service


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Apakah Plebitis? Bila insersi infus mengalami:..

Sakit Merah Bengkak Assessment Image

BukanPlebitis

Plebitis

Bengkak/infiltrasi

Infiltrasi dan atauPlebitis


IV Monitoring, kapan dilakukan??

The INS IV Assessment - Journal of Infusion Nursing, 2011

infusnon iritan Dapat

memberitahupetugas

Kritikal pasien Obatsedative Tdk dapat

memberitahupetugas

Pasien bayi Anak

infusiritan secaraperiferalpemberiannyadibatasi 30 60

Setiap 4 jam Setiap 1 2 jam Setiapjam 5 10 menit


Pasien anak paling sering membutuhkan monitoring

Kateter IV tak perlu dilepas tiap 72 jam hari kecualiada indikasi klinis.

The risk for phlebitis in children has not increased with theduration of catheterization (page 28)

CDC, 2011


Andrew Jackson


Routine Observation & Monitoring

Evaluate the catheter insertion site daily bypalpation and by inspection if transparentdressing is in use. (Guideline, 2011)CDC: Page 13

www.cdc.gov

Practice Criteria I: The catheter-skin junctionsite should be visually Inspected or palpateddaily for (INS, 2011)INS: Page S-22 Practice 14.1

www.ins1.org

Centers for Disease

Control and Prevention

Infusion Nurses Society


Jangan gunakan transparandressing yg memiliki pad

Pasien takut luka tusukan terlihat?.....

Jangan gunakan kasa lagi

untuk menutup luka tusukan

Berikan edukasi kepada pasien tujuan

penggunaan Transparan dressing.


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A comparison of transparent polyurethane and dry gauze dressings for

peripheral i.v. catheter sites: rates of phlebitis, infiltration, anddislodgment by patients (KA tripepi, KD Woods & MC Loach)

CONCLUSION:Transparent polyurethane dressings gives:

1. The decreased disruption of the i.v. therapy and

2. Low rates of phlebitis or infiltration compare to gauze & tapes.

It prefer to use transparent polyurethane rather than gauze at insertionsites for peripheral i.v. catheters.

AJCCAmerican Journal of Critical Care

3M Critical & Chronic Care Solutions CLABSI Overview

It is estimated that more than 5 million CVCs are inserted each year; any patient with acentral line is at risk of developing a CLABSI.

The U.S. Centers for Disease Control and Prevention recently estimated the annual cost> $1 billion, cost per patient > $16,000.

Developing countries, where the rates of HAIs related to devices are, in most cases,three to five times greater.

The Joint Commission, in collaboration with Joint Commission Resources (JCR) andJoint Commission International (JCI), developed a new monograph containing the mostcurrent information, evidence-based guidance and resources to help health careorganizations reduce the current risks and resulting harm associated with CLABSI.

26 3M 2013. All Rights Reserved.

(OAKBROOK TERRACE, Ill. May 16, 2012)Central line-associated bloodstream infections (CLABSIs) area serious form of health care-associated infections ( HAIs), witha mortality rate of 12 to 25 percent in the United States alone.


Central Line Bundle/IV Bundle for CR-BSI Prevention

1.1.1.1. Hand HygieneHand HygieneHand HygieneHand Hygiene

2.2.2.2. Maximal Barrier PrecautionMaximal Barrier PrecautionMaximal Barrier PrecautionMaximal Barrier Precaution

3.3.3.3. Chlorhexidine (CHG) skin antisepsisChlorhexidine (CHG) skin antisepsisChlorhexidine (CHG) skin antisepsisChlorhexidine (CHG) skin antisepsis

4.4.4.4. Optimal catheter site selectionOptimal catheter site selectionOptimal catheter site selectionOptimal catheter site selection

5.5.5.5. Daily review of line necessityDaily review of line necessityDaily review of line necessityDaily review of line necessity

IHI (institute Healtcare Improvement) tahun 2006


Optimal site selection

Pemilihan tempat pemasangan CVCberdasarkan pertimbangan resikomekanikal dan infeksi. Cat 1APosted on Mar 18, 2013

Fankhauser, G.T., Fowl, R.J., Stone, W.M. and Money,S.R. (2013)Elimination of pneumothoraxandhemothoraxduring placement of implantable venous

access ports using ultrasound and fluoroscopicguidance. Vascular. March 14th.

Use subclavian site rather than a jugular orfemoral site in adult patient t o minimizeinfection risk for nontunnelled CVCplacement. Cat 1B

For tunneled CVC unresolved issue.


Daily review of line necessityDaily review of line necessityDaily review of line necessityDaily review of line necessity

Menghindari pelepasan kateter yangtidak perlu

Use a sutureless securement device toreduce the risk of infection for

intravascular catheters (Cat II) Use a chlorhexidine impregnated sponge

dressing for temporary short-termcatheters in patients older than 2 monthsof age if the CLABSI rate, (Cat 1b)

CHG Impregnated


30 3M 2013. All Rights Reserved.


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3M Critical & Chronic Care Solutions Peripheral Care; Kasa + Plester

NursingLabor

Catheter

Skin prep

Dressing ?

Insertion

June 10

8am

June 11

8am

June 12

8am

June 13

8am

24

hours

48

hours

72

hours

+

+

+NursingLabor

Skin prep

Gauze+Tapes

+

+

3M Critical & Chronic Care Solutions Peripheral Care; Tegaderm

NursingLabor

Catheter

Skin prep

Dressing ?

Insertion

June 10

8am

June 11

8am

June 12

8am

June 13

8am

24

hours

48

hours

72

hours

+

+

+TEGADERM

Transparent Dressing


Cost Analisa; Kasa+plester

Tambhan CostKemungkinan Kateter Lepas

Paramater jaminan sterilisasiExternal indikator

Internal indikator

ProduktifitasMemotong kasa membungkus

Tempat Kasa & Pengemas

Proses SterilisasiAir dan listrikPetugas CSSD


Mengoptimalkan fiksasi dg Tegaderm dressing

Pastikan kulit bersih dari kotoran dan kering

Lakukan skin prep dengan alkohol swab (3xlebih baik) dan pastikan kering

Lakukan penekanan pada permukaantransparan dressing: hub kateter, sayap danpermukaan

Lakukan penekanan pada sekeliling padasaat melepas linernya

Beri tambahan plester pada hub kateter

3M2007. All


Contoh applikasi transparan Dressing yang kurang Tepat

3M2007. All

Plester tambahan menututupi area monitoring


Contoh applikasi / Practice

3M2007. All

Perlu tambahan plestersekitar sambungan hubkateter. Jangan fiksasi kateter

infus dibawahtransparan dressing.

Fiksasi Spalek janganmenutupi daerahinsersi.


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3M Critical & Chronic Care SolutionsFeature & Benefit

Lebihtipis &HipoalergenikNyaman & minimal reaksi alergi

Lebih Transparent:Memudahkanmonitoringtempat tusukan antisipasi

plebitis.

Window delivery system:Memudahkanpemasangan

DilengkapiLabel:Menuliskan jam, tglpemasangan&nama inisialpemasangnya.

Complete Size VariantTersediaberbagai ukuran untukpasienbayi-dewasa

Effective & EffisienDapat dipasangselama3hrmengurangipergantian dressing

Tegaderm Transparent I.V.


TM 1623Catheter Port

Tegaderm Tanpa Plester tambahan

TM 1624Catheter tanpa

Port

TM 1622Infus pada Bayi


Tegaderm IV dengan tambahan plester

TM 1610Infus padaanak

TM 1633 Untuk kateterPort / lurus


Tegaderm CVC

TM 1626 tanpa plestertambahan TM 1635 TM 1655Border sekeliling


3M 2009. All Rights Reserved.

Dressing Original Frame IV CentralDressing Plus


Transpore

Fiksasi selang infus Transparan memudahkan untuk

memonitor bila ada emboli,trombus

Mudah dirobek vertikal atau

horisontal tanpa pemotong Dapat juga untuk fiksasi Doppengaman mata.


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X

Update News

Satu rol plester untuksatu orang pasienjangan di share

Beberapa Study:

74 % of sample taken from

40partial-use rolls had somebacteria growth (1974)

5 year outbreak of methicilin-

susceptible staphylococus aureusamong 202 babies in a neonatal

unit in which the infection wasrelated to an adhesive used as a

skin protectant. (Wilcox, et al, 2000)

Tape source of contamination at 3hospitals in the hunter new Englandarea health service (Haris, et al2012).


Skin Damage Associated With Intravenous Therapy:Common Problems and Strategies for Prevention

Infusion therapy approximately 90% hospital and estimated 1.3 million homeinfusion / year

Some experience alterations in skin integrity which are limited published dataassociated with infusion therapy, and the etiology of damage has not beenpreviously described in detail.

In which adhesive wear is a constant and localized, superficial skin damage iscommon. This article will offer a WOC nursing perspective of skin damage andseek to provide a context for understanding and preventing skin damage in theinfusion therapy patient.

3M2007. All

Journal of Infusion Nursing: November/December 2012Volume 35 -Issue 6 - p 390401 doi: 10.1097/NAN.0b013e318270a91e(Thayer, Debra MS, RN, CWOCN)


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iv management from 3m

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