Plebhitis.ppt

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PENCEGAHAN DAN

PENGENDALIAN PLEBITIS

Disampaikan Disampaikan Pada

Pada PelatihPelatihan an PPI PPI DasarDasar PERSI

PERSI Jakarta, 2 ! 2" N

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P()() BAHASAN

 _Pendah*l*an_Pendah*l*an  _Pen+ertian_Pen+ertian 

 ___akt#r_akt#r_!-akt#r_!-akt#r_.an+_.an+

mempen+ar*hi

ple$itis



 Pen/e+ahan Pen/e+ahan dan dan pen+endaliapen+endaliann

ple$itis

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PENDAH0L0AN

Pemasan+an in-*s melal*i 1ena

peri-er dapat

peri-er dapat $erisik$erisik# teradin.a# teradin.a

ple$itis

The incidence of infusion phlebitis is

estimated to be as high as

estimated to be as high as 62% of62% of

patients with an intraven

patients with an intravenous accessous access

device in place (Lundgren, Jordfeldt

& E !""#$

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Insi#den Rate Ple$itis Perseri$* Hari Pemakaian Alat 3 4 5

di RS Jant*n+ Harapan )ita Peri#de Tah*n 2%%6 s7d 2%&2

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PENGERTIAN

 _{Peradan+an pada 1ena peri-er}

 _{Ple$itis serin+ dih*$*n+kan den+an}

pem$ent*kan $ek*an darah

3tr#m$#sis5 Tr#m$#8e$itis

 _{Se/ara klinis adan.a kel*han n.eri,}

n.eri tekan, $en+kak, pen+erasan, eritema dan han+at pada 1ena #leh karena peradan+an, in-eksi dan7ata*

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TANDA !TANDA

PLEBITIS

 _{Se/ara klinis 9}

Ada n.eri, n.eri

tekan,$en+kak,pen+erasan, eritema dan han+at pada 1ena

 _{Jika in-eksi 9}

)emerahan, demam, sakit, $en+kak,

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Pat#:si#l#+i

Menyebabkan Kerusakan

dan iritasi PB akt#r eti#l#+i ple$itis

3sp#ntan, k#mplikasi , p;san+an in-*s) Pengaruh penurun histamine, bradikinin, dan serotonin Nyeri Permeabilitas kapiler me ↑

Penumpukan cairan & protein di intertitial space Terbentuknya faktor procoagulan di endothelial Mengaktifasi proacugulan Collect leukosit ipertermi a Tidak diatasi !n"ammato ry continued #dema dan tenderness

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A)T(R !A)T(R <ANG

=E=PENGAR0HI PLEBITIS

 _0sia

 _{Jenis kelamin}

 _{)#ndisi dasar 3 dia$etes}

melit*s,

in-eksi, l*ka $akar 5

 _{akt#r kimia seperti #$at ata*}

/airan .an+ iritan

 _{akt#r mekanis seperti $ahan,}

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Catheter Related In-e/ti#n

Risk

Vein SKIN ORGANISMS Endogenous Flora Extrinsic HCW Contam Disinfectant Invading Wound CONTAMINATION OF CATHETER HUB Extrinsic (HCW) Endogenous (Skin) CONTAMINATION OF DEVICE PRIOR TO INSERTION Extrinsic Vein SKIN ORGANISMS Endogenous Flora Extrinsic HCW Contam Disinfectant Invading Wound CONTAMINATION OF CATHETER HUB Extrinsic (HCW) Endogenous (Skin) CONTAMINATION OF DEVICE PRIOR TO INSERTION Extrinsic Fibrin !heath" Thromb! HEMATOGENOUS" From #i!tant $o%a$ In&e%tion

Contaminate# In&!ate

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INS >is*al In-*si#n Phle$itis 3>?I?P?5 S/#re, 2%% IVsiteappearshealthy NopainatIVsite,noerythema, Noswelling Nopalpablevenouscord(allages)

0 N# si+ns #- phle$itis_{(BSER>E CANN0LA}

•Erythemaataccesssite

•Withorwithoutpain 1

$ St#p in-*si#n i- p#ssi$le

$ Identi-. additi#nal res#*r/es -#r mana+ement

$ Rem#1e I> i- s.mpt#ms persist

• Erythema

•Painataccesssite

• With or without edema 2

$ St#p in-*si#n i- p#ssi$le

$ Identi-. additi#nal res#*r/es -#r mana+ement

$ Rem#1e I> i- s.mpt#ms persist

•Erythema •Painataccesssite • With or without edema •Streakformation •Palpablevenouscord 3 $ St#p in-*si#n i- p#ssi$le $ Identi-. additi#nal res#*r/es

-#r mana+ement $ Rem#1e I>

$ N#ti-. primar. ser1i/e • Erythema

•Painataccesssite • With or without edema •Streakformation

•Palpablevenouscord>1inch • Purulent drainage

4

$ St#p in-*si#n and esta$lish alternate I> site

$ Rem#1e I> and /*lt*re site and /ath tip

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In:ltrati#n S/ale 3INS 2%%5

No symptoms 0

• Skin blanched

• Edema < 1 inch in any direction •Cooltotouch

• With or without pain

1

•Skin blanched

•Edema1–6inchesinanydirection •Cooltotouch • With or without pain 2 •Skinblanched,translucent •Grossedema>6inchesinanydirection •Cooltotouch • Mild to moderate pain • Possible numbness 3 •Skinblanched,translucent •Skintight,leaking •Skindiscolored,bruised,swollen •Grossedema>6inchesinanydirection •Deeppittingtissueedema • Circulatory impairment • Moderate – severe pain

Iﬁltrati of tofblood rod ctirrit torvesi t

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&?Ple$itis )imia

2? Ple$itis =ekanis

'? Ple$itis Bakterial

ENIS – ENIS

PLEBITIS

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&?Ple$itis )imia

 pH dan #sm#laritas /airan in-*s .an+ ekstrem pH @, #sm#laritas 

 _{=ikr#partikel .an+ terlar*t} _.an+

ter$ent*k $ila partikel #$at tidak lar*t semp*rna selama pen/amp*ran

pem$erian #$at intra1ena

men++*nakan :lter & sampai 6 m?

 Pemilihan material kateter intra1ask*ler .an+

di+*nakan silik#n dan p#li*retan k*ran+ $ersi-at

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impunan Pera%at Pencegah dan

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2? PLEBITIS =E)ANIS  _{Penempatan kateter}

intra1ask*ler .an+ tidak tepat  _{0k*ran kateter intra1ask*ler}

.an+ tidak ses*ai den+an *k*ran 1ena

 _{Cara pemasan+an, pen+aasan} dan peraatan .an+ k*ran+

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'? PLEBITIS BA)TERIAL

 _{and h'giene tidak dilak*kan}

 _{Preparasi k*lit tidak $aik se$el*m}

pemasan+an in-*s

 _{Teknik aseptik tidak $aik saat akan}

pem$erian #$at ata* /airan

 _{)ateter dipasan+ terlal* lama}

 _{Tempat T*s*kan )ateter tidak7 aran+}

diinspeksi se/ara 1is*al

 _{Alat ! alat .an+ di +*nakan r*sak ata*}

$#/#r ata* kadal*arsa

 _{Lar*tan in-*s terk#ntaminasi karena}

teknik aseptik .an+ k*ran+ $aik pada saat pen/amp*ran lar*tan

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PENATALA)SANAAN PENCEGAHAN PLEBITIS

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2

? PREPARASI )0LIT

 *se alcohol follo%ed by application of main disinfectant (+ Po-idone !odine or .

Chlorhe/idine prep0

 _{Pro-ides immediate kill as %ell as residual}

acti-ity

 1or !odophor ' .'2 hrs

 1or Chlorhe/idine prep0 ' 3 hrs

 Process ' . 4teps

 _{5pply alcohol in circular motion out%ards,}

allo% it to dry

 5pply Po-idone !odine or Chlorhe/idine in circular motion

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'? DRESSING 7 PEN0T0P IN0S

 0se either sterile +a*e #r sterile transparent,

semi permea$le dressin+ t# /#1er the /atheter site

_{Repla/e /atheter dressin+ i- the}

dressin+ $e/#mes

damp, l##se, #r 1isi$l. s#iled

 Repla/e dressin+s at e1er. 2 da.s -#r

+a*e

dressin+ and 2 h#*r -#r transparent

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F?Catheter /are  l*shin+

 _{All 1as/*lar a//ess de1i/es *sed sh#*ld $e 8*shed ith}

%?" s#di*m /hl#ride

normal saline) or heparin to6

 Maintain catheter patency

 Pre-ent contact bet%een incompatible "uids and medications

 Appr#priate l*shin+ helps t# red*/e /atheter thr#m$#sis and th*s CRBSI risk

 5s thrombi or 7brin deposits could ser-e as a nidus for microbial coloni8ation

 hen /atheter 8*shin+ is t# $e per-#rmed

 9ust after catheter insertion

 Before and after each administration of medication

 od sampling

 #-ery 3': hours %hen catheter is not in use ;nce a day ' home care P!CC<s )

 INS standards, 2%%

 4ingle use "ushing systems to be used, that is, do not use multiple use -ials

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6? Appr#priate *se #-e*ipment

&? Intra1as*lar A//ess

Monitor and inspect catheter site regularly, the site should be

obser-ed for any signs of in"ammation, infection or malfunction

2?#r an. intra1as/*lar a//ess

 eplace !@ tubing and add on de-ices no more freFuently than G.

hours

 eplace tubing used to administer blood products or lipids %ith in . hrs

Clean inHection ports %ith G+ alcohol or an iodophor before accessing

'?I>D repla/ement

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The Peripheral >as/*lar Catheter

3P>C5 B*ndle

(0 Performed hand hygiene before and after all P@C procedures

.0 Checking the P@Cs insitu are still reFuared

20 emo-ing P@Cs %here there is e/tra -asation or in"amation

0 Checking P@C dressing are intact D0 Considering remo-al of P@Cs insitu

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- _{Pengumpulan data setiap hari} - _{Perhitungan setiap bulan}

- _{Eaporan setiap bulan,tri%ulan,semester,}

tahunan

- _{!nsiden rate Plebitis}

9umlah plebitis

''''''''''''''''''''''''''''''''' J (+++   ‰ )

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