IV Management From 3M
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3M Critical & Chronic Care Solutions
3M2009. All
Tromboplebitis
2) Mekanik: Extravasasi
Komplikasi pemasangan Infus1) Inflamasi: Plebitis
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
Infusion Procedure
Persiapan Insersi Perawatan
3M Critical & Chronic Care Solutions
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
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3M Critical & Chronic Care Solutions
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.
3M Critical & Chronic Care Solutions
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
.
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
Untuk Memudahkan monitoringLuka tusuk infus Untukmengantisipasi terjadinya plebitis
3M Critical & Chronic Care Solutions
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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3M Critical & Chronic Care Solutions
Apakah Plebitis? Bila insersi infus mengalami:..
Sakit Merah Bengkak Assessment Image
BukanPlebitis
Plebitis
Bengkak/infiltrasi
Infiltrasi dan atauPlebitis
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
Andrew Jackson
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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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3M Critical & Chronic Care Solutions
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.
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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.
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
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
3M Critical & Chronic Care Solutions
Contoh applikasi transparan Dressing yang kurang Tepat
3M2007. All
Plester tambahan menututupi area monitoring
3M Critical & Chronic Care Solutions
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.
3M Critical & Chronic Care Solutions
TM 1623Catheter Port
Tegaderm Tanpa Plester tambahan
TM 1624Catheter tanpa
Port
TM 1622Infus pada Bayi
3M Critical & Chronic Care Solutions
Tegaderm IV dengan tambahan plester
TM 1610Infus padaanak
TM 1633 Untuk kateterPort / lurus
3M Critical & Chronic Care Solutions
Tegaderm CVC
TM 1626 tanpa plestertambahan TM 1635 TM 1655Border sekeliling
3M Critical & Chronic Care Solutions
3M 2009. All Rights Reserved.
Dressing Original Frame IV CentralDressing Plus
3M Critical & Chronic Care Solutions
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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3M Critical & Chronic Care Solutions
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).
3M Critical & Chronic Care Solutions
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)
3M Critical & Chronic Care Solutions
Terimakasih
Further Question:
08119003405