Plebhitis.ppt 1u5f1d

PENCEGAHAN DAN PENGENDALIAN PLEBITIS

Disampaikan Pada Pelatihan PPI Dasar PERSI Jakarta, 26 – 29 Nopember 2013

POKOK BAHASAN  Pendahuluan  Pengertian  Faktor –faktor yang mempengaruhi plebitis  Pencegahan dan pengendalian plebitis

PENDAHULUAN Pemasangan infus melalui vena perifer dapat berisiko terjadinya plebitis The incidence of infusion phlebitis is estimated to be as high as 62% of patients with an intravenous access device in place (Lundgren, Jordfeldt & Ek 1993).

Insioden Rate Plebitis Perseribu Hari Pemakaian Alat ( ‰ ) di RS Jantung Harapan Kita Periode Tahun 2005 s/d 2012

PENGERTIAN  Peradangan pada vena perifer

 Plebitis sering dihubungkan dengan pembentukan bekuan darah (trombosis)  Tromboflebitis  Secara klinis adanya keluhan nyeri, nyeri tekan, bengkak, pengerasan, eritema dan hangat pada vena oleh karena peradangan, infeksi dan/atau

TANDA –TANDA PLEBITIS

 Secara klinis : Ada nyeri, nyeri tekan,bengkak,pengerasan, eritema dan hangat pada vena Jika infeksi : Kemerahan, demam, sakit, bengkak,



Patofisiologi Faktor etiologi plebitis (spontan, komplikasi , p’sangan infus) Pengaruh penurun Menyebabkan histamine, Kerusakan bradikinin, dan dan iritasi PB serotonin

Nyeri

Tidak diatasi Terbentuknya faktor procoagulan di endothelial

Permeabilitas kapiler me ↑ Penumpukan cairan & protein di intertitial space Edema dan tenderness

Mengaktifasi proacugulan Collect leukosit

Hipertermi a

Inflammato ry continued

FAKTOR –FAKTOR YANG MEMPENGARUHI PLEBITIS

 Usia  Jenis kelamin  Kondisi dasar ( diabetes melitus, infeksi, luka bakar )  Faktor kimia seperti obat atau cairan yang iritan  Faktor mekanis seperti bahan, ukuran kateter, lokasi dan lama kanulasi

Catheter Related Infection Risk Catheter site SKIN ORGANISMS Endogenous Flora Extrinsic HCW Contam Disinfectant Invading Wound

CONTAMINATION OF CATHETER HUB Extrinsic (HCW) Endogenous (Skin)

CONTAMINATED INFUSATE Fluid Medication Contaminated Extrinsic Infusate

CONTAMINATION OF DEVICE PRIOR TO INSERTION Extrinsic

Skin Vein

Fibrin Fibrinsheath, Sheath Thrombus Thrombus

HEMATOGENOUS HEMATOGENOUS, From Distant Local Infection From distant local Infection

INS Visual Infusion Phlebitis (V.I.P.) Score, 2006 IV site appears healthy No pain at IV site, no erythema, No swelling No palpable venous cord (all ages) • Erythema at access site • With or without pain • Erythema • Pain at access site • With or without edema • Erythema • Pain at access site • With or without edema • Streak formation • Palpable venous cord • Erythema • Pain at access site • With or without edema • Streak formation • Palpable venous cord > 1 inch • Purulent drainage

0

No Nosigns signsof ofphlebitis phlebitis OBSERVE CANNULA OBSERVE CANNULA

1

••Stop Stopinfusion infusionififpossible possible ••Identify additional Identify additionalresources resources for management for management ••Remove RemoveIV IVififsymptoms symptomspersist persist

2

••Stop Stopinfusion infusionififpossible possible ••Identify additional Identify additionalresources resources for management for management ••Remove RemoveIV IVififsymptoms symptomspersist persist

3

••Stop infusion if possible Stop infusion if possible ••Identify additional resources Identify additional resources for formanagement management • Remove IV • Remove IV ••Notify primary service Notify primary service

4

••Stop infusion and establish alternate Stop infusion and establish alternate IV IVsite site ••Remove IV and culture site and cathe Remove IV and culture site and cath tip tip ••Notify primary service Notify primary service

Infiltration Scale (INS 2006) No symptoms

0

• Skin blanched • Edema < 1 inch in any direction • Cool to touch • With or without pain

1

• Skin blanched

• Edema 1 – 6 inches in any direction • Cool to touch • With or without pain

2

• Skin blanched, translucent • Gross edema > 6 inches in any direction • Cool to touch • Mild to moderate pain • Possible numbness

3

• Skin blanched, translucent • Skin tight, leaking • Skin discolored, bruised, swollen • Gross edema > 6 inches in any direction • Deep pitting tissue edema • Circulatory impairment • Moderate – severe pain • Infiltration of any amount of blood product, irritant, or vesicant

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JENIS – JENIS PLEBITIS 1.Plebitis Kimia 2. Plebitis Mekanis 3. Plebitis Bakterial

1.Plebitis Kimia  pH dan osmolaritas cairan infus yang ekstrem  pH ↓, osmolaritas ↑  Mikropartikel yang terlarut  yang terbentuk bila partikel obat tidak larut sempurna selama pencampuran  pemberian obat intravena menggunakan filter 1 sampai 5 µm. 

Pemilihan material kateter intravaskuler yang digunakan  silikon dan poliuretan kurang bersifat iritasi dibanding politetrafluoroetilen

Himpunan Perawat Pencegah dan Pengendali Infeksi Indonesia (HIPPII)- Pusat

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2. PLEBITIS MEKANIS  Penempatan kateter intravaskuler yang tidak tepat  Ukuran kateter intravaskuler yang tidak sesuai dengan ukuran vena  Cara pemasangan, pengawasan dan perawatan yang kurang baik

3. PLEBITIS BAKTERIAL  Hand hygiene tidak dilakukan  Preparasi kulit tidak baik sebelum pemasangan infus  Teknik aseptik tidak baik saat akan pemberian obat atau cairan  Kateter dipasang terlalu lama  Tempat Tusukan Kateter tidak/ jarang diinspeksi secara visual  Alat – alat yang di gunakan rusak atau bocor atau kadaluarsa  Larutan infus terkontaminasi karena teknik aseptik yang kurang baik pada saat pencampuran larutan  Faktor virulen instrinsik dari

PENATALAKSANAAN PENCEGAHAN PLEBITIS 1.HAND HYGIENE

2.

PREPARASI KULIT

 Use alcohol followed by application of main disinfectant 10% Povidone Iodine or 2% Chlorhexidine prep.  Provides immediate kill as well as residual activity  For Iodophor - 2-3 hrs  For Chlorhexidine prep. - 6 hrs  Process - 2 Steps  Apply alcohol in circular motion outwards, allow it to dry  Apply Povidone Iodine or Chlorhexidine in circular motion

3. DRESSING / PENUTUP INFUS  Use either sterile gauze or sterile transparent, semi permeable dressing to cover the catheter site  Replace catheter dressing if the dressing becomes damp, loose, or visibly soiled  Replace dressings at every 2 days for gauze CDC, Centre for Disease Control and Prevention, Guidelines forfor prevention of Intravascular dressing and 72 hour transparent catheter related Infections, MMWR, 2002: 51 ( No. RR 10 )

4.Catheter care - Flushing All vascular access devices used should be flushed with 0.9% sodium chloride (normal saline) or heparin to*  Maintain catheter patency  Prevent between incompatible fluids and medications 

 Appropriate Flushing helps to reduce catheter thrombosis and thus CR-BSI risk**  As thrombi or fibrin deposits could serve as a nidus for microbial colonization  When catheter flushing is to be performed  Just after catheter insertion  Before and after each istration of medication  od sampling  Every 6-8 hours when catheter is not in use (Once a day - home care PICC’s )  INS standards, 2006  Single use flushing systems to be used, that is, do not use multiple use vials

5. Appropriate use of equipment

1. Intravasular Access

Monitor and inspect catheter site regularly, the site should be observed for any signs of inflammation, infection or malfunction

2.For any intravascular access  Replace IV tubing and add on devices no more frequently than 72 hours  Replace tubing used to ister blood products or lipids with in 24 hrs Clean injection ports with 70% alcohol or an iodophor before accessing

3.IVD replacement  Peripheral Venous : 72-96 hrs in adults / first signs of

The Peripheral Vascular Catheter (PVC) Bundle 1. Performed hand hygiene before and after all PVC procedures 2. Checking the PVCs insitu are still requared 3. Removing PVCs where there is extra vasation or inflamation 4. Checking PVC dressing are intact 5. Considering removal of PVCs insitu longer than 72 hours

• Pengumpulan data setiap hari • Perhitungan setiap bulan • Laporan setiap bulan,triwulan,semester, tahunan • Insiden rate Plebitis: Jumlah plebitis --------------------------------)

Hari pemakaian IV Kateter

X 1000 =

(‰

Himpunan Perawat Pencegah dan Pengendali Infeksi Indonesia (HIPPII)- Pusat

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