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Terapi Terapi Infus & Infus & FlebotomiFlebotomi

Alfrina HanyAlfrina Hany

Follow Up LAKESMAFollow Up LAKESMA

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OUTLINEOUTLINE

Definisi & IndikasiDefinisi & Indikasi Jenis injeksiJenis injeksi Cara melakukan injeksi Cara melakukan injeksi Alat yang digunakanAlat yang digunakan Prosedur keamananProsedur keamanan Cara melakukan Flebotomi & infus yang Cara melakukan Flebotomi & infus yang

benarbenar

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DefinisiDefinisi

Prosedur invasif yang banyak Prosedur invasif yang banyak dilakukan di RSdilakukan di RS

Memasukkan kateter ke dalam Memasukkan kateter ke dalam pembuluh darah dengan tujuan pembuluh darah dengan tujuan tertentutertentu

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TujuanTujuan

Nutrisi parenteralDialisisTransfusi darah/plasma/dllhemodynamic monitoringdiagnostic testingResusitasi cairan dan obat.

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Jenis InjeksiJenis Injeksi

Intra vena : Perifer dan sentralIntra vena : Perifer dan sentral Lain : Intra vena, intra dermal, Lain : Intra vena, intra dermal,

Intramuskular, subkutanIntramuskular, subkutan

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Cara melakukan injeksiCara melakukan injeksi

Persiapan alatPersiapan alat Persiapan klienPersiapan klien Persiapan dokter/perawatPersiapan dokter/perawat Pemilihan lokasiPemilihan lokasi Tindakan injeksiTindakan injeksi Evaluasi respon klien & komplikasiEvaluasi respon klien & komplikasi

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Persiapan klienPersiapan klien

Kaji pengetahuan klienKaji pengetahuan klien Beritahukan tujuanBeritahukan tujuan Minta klien bekerjasamaMinta klien bekerjasama

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Persiapan Anda : Persiapan Anda : Prosedur Prosedur keamanankeamanan

Universal precaution : cuci tanganUniversal precaution : cuci tangan Standar precaution : sarung Standar precaution : sarung

tangan, masker, scort, googletangan, masker, scort, google Infeksi : sampah medis, kontainer Infeksi : sampah medis, kontainer

benda tajam, alat disposible benda tajam, alat disposible

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PERSIAPAN ALAT INJEKSIPERSIAPAN ALAT INJEKSI

Spuit/syringe : ukuran sesuai Spuit/syringe : ukuran sesuai kebutuhankebutuhan

Sarung tanganSarung tangan TurniketTurniket Alkohol swabAlkohol swab Alas perlak Alas perlak

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Pemilihan lokasiPemilihan lokasi

Sangat menentukan keberhasilanSangat menentukan keberhasilan ““FEEL IT”, Sight is not enoughFEEL IT”, Sight is not enough Penekanan diperlukanPenekanan diperlukan Hindari area sendi fleksiHindari area sendi fleksi Mulai area distal dulu menuju proksimal Gunakan sarung tangan Tidak ditepuk2

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Veins of the Upper Veins of the Upper ExtremitiesExtremities

DigitalisDigitalis

-sepanjang lateral jari, mudah nyeri, sulit untuk mobilisasi

MetacarpalMetacarpal

-Lokasi antara sendi dan tulang metacarpal

-Terbentuk dari banyak vena digitalis

-Pasien Geriatric : turgor kulit dan jaringan adiposanya sudah tidak baik

Digital

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Veins of the Upper ExtremitiesVeins of the Upper Extremities

CephalicCephalic -Mulai radialis pergelangan

tangan -Akses sepanjang tangan (hati2

arteri/saraf radialis)

Medial CephalicMedial Cephalic - Tepat di bawah sendi pada

lengan - Bisa memakai kateter yang

ukuran besar

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Veins of the Upper ExtremitiesVeins of the Upper Extremities

BasilicaBasilica

- Originates from the ulner side of the metacarpal veins and runs along the medial aspect of the arm. It is often overlooked becauses of its location on the “back” of the arm, but flexing the elbow/bending the arm brings this vein into view

Medial BasilicMedial Basilic - Empties into the Basilic vein

running parallel to tendons, so it is not always well defined. Accepts larger gauge catheters.

- BEWARE of Brachial Artery/Nerve

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Tindakan InjeksiTindakan Injeksi

• Gunakan sarung tangan. • Pasang turniket• Desinfeksi• Masukkan jarum dengan sudut 30• Penanda darah pada ujung tabung• Aspirasi• Masukkan cairan/ambil spesimen• Ambil kapas alkohol• Tekan kapas pada lokasi insersi sambil

mencabut jarum• Evaluasi respon klien

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PERSIAPAN ALAT INFUSPERSIAPAN ALAT INFUS

Cairan infusCairan infus Venflon/abocathVenflon/abocath Selang infusSelang infus Kasa steril/veca-CKasa steril/veca-C PlesterPlester Jam tangan detikJam tangan detik Tiang infus Tiang infus

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VenflonVenflon

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Tindakan infusTindakan infus

Siapkan cairan pada tiangSiapkan cairan pada tiang Siapkan selang infusSiapkan selang infus Pilih lokasiPilih lokasi Pasang turniketPasang turniket Pasang sarung tanganPasang sarung tangan Masukkan jarumMasukkan jarum lihat penanda darahlihat penanda darah

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Tindakan infusTindakan infus

Tarik sedikit jarum dari kanul perlahanTarik sedikit jarum dari kanul perlahan Masukkan kanul ke dalam venaMasukkan kanul ke dalam vena Fiksasi dan s iapkan selangFiksasi dan s iapkan selang Tarik jarum seluruhnyaTarik jarum seluruhnya Sambungkan kanul dengan selangSambungkan kanul dengan selang Buka selang infusBuka selang infus Pasang balutanPasang balutan Hitung tetesan infusHitung tetesan infus

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The IV Fluid SupermarketThe IV Fluid Supermarket CrystalloidsCrystalloids

Dextrose in waterDextrose in water D5WD5W D10WD10W D50WD50W

SalineSaline Isotonic (0.9% or Isotonic (0.9% or

“normal”)“normal”) Hypotonic (0.45%, 0.25%)Hypotonic (0.45%, 0.25%) HypertonicHypertonic

ComboCombo D51/2NSD51/2NS D5NSD5NS D10NSD10NS

Ringer’s lactate Ringer’s lactate “physiologic”.“physiologic”.(K, HCO3, Mg, Ca)(K, HCO3, Mg, Ca)

ColloidsColloids AlbuminAlbumin

5% in NS5% in NS 25% (Salt Poor)25% (Salt Poor)

DextransDextrans HetastarchHetastarch

BloodBlood

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Persiapan alat VacutainerPersiapan alat Vacutainer

HolderHolder TabungTabung SyringeSyringe Alcohol swabAlcohol swab kasakasa

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TabungTabung

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Tindakan VacutainerTindakan Vacutainer

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Tindakan VacutainerTindakan Vacutainer

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Potential ComplicationsPotential Complications

Sepsis (infection)Sepsis (infection) HematomaHematoma CellulitisCellulitis ThrombosisThrombosis PhlebitisPhlebitis

Catheter Catheter fragment fragment embolismembolism

InfiltrationInfiltration Air embolismAir embolism

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Infiltration/ExtravasationInfiltration/Extravasation

The most common cause is damage to the wall during insertion or angle of placement.

STOP INFUSION and treat as indicated by Pharmacy, Medication package insert or drug reference book.

Notify MD and document

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Phlebitis/ThrombophlebitisPhlebitis/Thrombophlebitis

Chemical

- Infusate chemically erodes internal layers. Warm compresses may help while the infusate is stopped/changed. Anti-inflammatory and analgesic medications are often used no matter what the cause Mechanical

- Caused by irritation to internal lumen of vein during insertion of vascular access device and usually appears shortly after insertion. The device may need to be removed and warm compresses applied

Bacterial

- Caused by introduction of bacteria into the vein. Remove the device immediately and treat w/antibiotics. The arm will be painful, red and warm; edema may accompany

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CellulitisCellulitis

Inflammation of loose connective tissue around insertion site.

- Caused by poor insertion technique

- Red swollen area spreads from insertion site outwardly in a diffuse circular pattern

- Treated w/antibiotics

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Septicemia/Pulmonary Edema/Septicemia/Pulmonary Edema/EmbolismEmbolism

Septicemia

- Severe infection that occurs to a system or entire body

- Most often caused by poor insertion technique or poor site care

- Discontinue device immediately, culture and treat appropriately Pulmonary edema- caused by rapid infusion

Pulmonary embolism - Caused by any free floating substances that require thrombolytic therapy for several months. Increased risk w/lower ext.

Air embolism- caused by air injected into IV system. Keep insertion site below level of heart

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Demonstration & PracticeDemonstration & Practice

Questions?Questions?