IV Management From 3M

3/21/2014
1
3M Critical & Chronic Care Solutions
3M 2013. All Rights Reserved.
Dudung Jafar Sidik
Professional Service
Critical & Chronic Care Solution Division (C3SD)
Materi disampaikan sebagai modul pada IV Team
Pencegahan Infeksi:
Phlebitis- IADP/BSI
Berdasarkan CDC Guideline tahun 2011
Device-associated infection rates
Device use, length of stay, and mortality in intensive care units
of 4 Chinese hospitals: Posted on Mar 27,
*) Total of 2,631 admissions to the 7 ICUs in the study hospitals ( August 2008-Jully 2010)
HAIs=Health Care Associated Infection MV=Mechanical Ventilator, CL=Central Line, UC=Urine catheter
2 3M 2013. All Rights Reserved.
Intravenous literature: Hu, B., Tao, L., Rosenthal, V.D., Liu, K., Yun, Y., Suo, Y., Gao, X., Li, R., Su, D., Wang, H., Hao, C., Pan, W. and
Saunders, C.L. (2013) International Nosocomial Control Consortium findings. AJIC: American Journal of Infection Control. 41(4), p.301-306.
HAIs*) Infection Rate
(device days)
Extra LOS
(Days)
Extra Mortality
(%)
VAP 10.46/1000 MV 20.5 22
CLABSI 7.66/1000 CL 15 14
CAUTI 1.29/1000 UC 27 43
CDC report 2011
3M
2007. All
Rights
2011 2010 Balance
All infections 18,113, 30,616 41%
Central line 3,472 2,242 Up
SSI 2,130 1,288 Up
Urinary Tract 1,807 981 Up
Events 14,315 15,398 7%
Hospital Blood Infections Down, CDC Says By Michael Smith, North American Correspondent, MedPage Today Published: February
12, 2013 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, BSN, RN, Nurse Planner
Hospitals Visit sharing:
Tan Tock seng:
Penggunaan transparan dressing
menurunkan phlebitis rate
KK women & Chlid:
Transparan Dressing juga digunakan
untuk bayi , untuk bayi kecil
memotong ukuran yg besar.
Kameda Hospital
Clinical Practice Guidelines
Use Transparent Dressing for all vascular access
Putting in VIP (Visual Infusion Phlebitis) Tool
JCI accreditation
JCI follows best practice, they are particular with documentation of care.
Does the hospital has an IV protocol?
Is the protocol following international guidelines?
Is this protocol being followed by nurses at the bedside?
Are the patients receiving the proper care?
Are the nurses documenting in the right documentation for IV care
received by the patient?
For any adverse event, are the nurses documenting this and reporting
it properly?
Are the patients receiving the proper care for this event?
Infeceksi Nosokomial: Health Care Associated Infection
Bloodstream: 87-90%
associated with an
intravascular device insertion.
ISK/UTI: 95% of associated
with a urinary catheter
application
86% of pneumonia are
associated with mechanical
ventilation (VAP)
ILO/SSI Site surgical wound.
Sagana, R. and Hyzy, R.C. (2013), posted by IV Team
3/21/2014
2
3M
2009. All
Rights
Tromboplebitis
2) Mekanik: Extravasasi
Komplikasi pemasangan Infus
1) Inflamasi: Plebitis
Uji Kompetensi Perawat
Memeriksa tanda-tanda vital
Menggunakan teknik antiseptik
Evaluasi respon terhadap
medikasi
Panduan Latihan Uji Kompetensi Perawat, 2012
Menggunakan prinsip standard precaution
Memasang, merawat dan melepas infus
Apakah Plebitis?
Bila insersi infus mengalami:..
Sakit Merah Bengkak

Faktor Penyebab Plebitis
Osmolaritas; <450 600>
Kadar pH: 7-7,4
Fiksasi Kateter
Hand hygiene
Skin Preparation
Perawatan luka tusuk:
Transparan dressing
bisa mencegah plebitis
Chemical
Mechanical
Micro biological
Infusion Procedure
Persiapan Insersi Perawatan
RL ? Aminoleban ?
Rujukan
DX 10% ?
Aminovel 600
? L : < 450
M : 450 - 600
H : > 600
pH : 7-7.4
DX 5% +
NaCl 0.9%
?
Amiparen
?
INS (Infusion Nursing Society)
Chemical
280 768
555
585
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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 Global IV Leadership Summit, 2011.
Teknik Antiseptik; Skin Preparation
Bagaimana Tekniknya?
The frictional back & forth & circle
clean the skin & antiseptic penetrate the skin
layers.
Mikroorganisme Residen
1 mm depth epidermis: 25 layers.
The first 5 of epidermis layers resided
by 80% resident MO.
Antiseptik Recommend
CHG have persistent activity
Dont use antimicrobial ointment.
AmericanAssociation of Blood Banks for donor site preparation.
Mekanisme 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 Transparan CVC
Jenis
Untuk Memudahkan monitoring
Luka tusuk infus Untuk
mengantisipasi terjadinya plebitis
INS Visual Infusion Phlebitis (V.I.P.) Score; 2011
IV site appears healthy
No pain at IV site, no erythema,
No swelling
No palpable venous cord (all ages)
0
No signs of phlebitis
OBSERVE 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
for management
Remove IV if symptoms persist
Erythema
Pain at access site
Streak formation
Palpable venous cord
3
for management
Remove IV
Notify primary service
Erythema
Pain at access site
Streak formation
Palpable venous cord > 1 inch
Purulent drainage
4
Stop infusion and establish alternate
IV site
Remove IV and culture site and catheter
tip
Notify primary service
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Apakah Plebitis? Bila insersi infus mengalami:..
Sakit Merah Bengkak Assessment Image

Bukan Plebitis
Plebitis
Bengkak/infiltrasi
Infiltrasi dan atau
Plebitis
IV Monitoring, kapan dilakukan??
The INS IV Assessment - Journal of Infusion Nursing, 2011
infus non iritan
Dapat
memberitahu
petugas
Kritikal pasien
Obat sedative
Tdk dapat
memberitahu
petugas
Pasien bayi
Anak
infus iritan secara
periferal
pemberiannya
dibatasi 30 60
Setiap 4 jam Setiap 1 2 jam Setiap jam 5 10 menit
Pasien anak paling sering membutuhkan monitoring
Kateter IV tak perlu dilepas tiap 72 jam hari kecuali
ada indikasi klinis.
The risk for phlebitis in children has not increased with the
duration of catheterization (page 28)
CDC, 2011
Andrew Jackson
Routine Observation & Monitoring
Evaluate the catheter insertion site daily by
palpation and by inspection if transparent
dressing is in use. (Guideline, 2011)
CDC: Page 13
www.cdc.gov
Practice Criteria I: The catheter-skin junction
site should be visually Inspected or palpated
daily for (INS, 2011)
INS: Page S-22 Practice 14.1
www.ins1.org
Centers for Disease
Control and Prevention
Infusion Nurses Society
Jangan gunakan transparan
dressing 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, and
dislodgment 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 insertion
sites for peripheral i.v. catheters.
AJCC
American Journal of Critical Care
CLABSI Overview
It is estimated that more than 5 million CVCs are inserted each year; any patient with a
central 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) and
Joint Commission International (JCI), developed a new monograph containing the most
current information, evidence-based guidance and resources to help health care
organizations reduce the current risks and resulting harm associated with CLABSI.
(OAKBROOK TERRACE, Ill. May 16, 2012)
Central line-associated bloodstream infections (CLABSIs) are
a serious form of health care-associated infections (HAIs), with
a 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 Hygiene Hand Hygiene Hand Hygiene Hand Hygiene
2. 2. 2. 2. Maximal Barrier Precaution Maximal Barrier Precaution Maximal Barrier Precaution Maximal Barrier Precaution
3. 3. 3. 3. Chlorhexidine (CHG) skin antisepsis Chlorhexidine (CHG) skin antisepsis Chlorhexidine (CHG) skin antisepsis Chlorhexidine (CHG) skin antisepsis
4. 4. 4. 4. Optimal catheter site selection Optimal catheter site selection Optimal catheter site selection Optimal catheter site selection
5. 5. 5. 5. Daily review of line necessity Daily review of line necessity Daily review of line necessity Daily review of line necessity
IHI (institute Healtcare Improvement) tahun 2006
Optimal site selection
Pemilihan tempat pemasangan CVC
berdasarkan pertimbangan resiko
mekanikal dan infeksi. Cat 1A
Posted on Mar 18, 2013
Fankhauser, G.T., Fowl, R.J., Stone, W.M. and Money,
S.R. (2013) Elimination of pneumothorax and
hemothorax during placement of implantable venous
access ports using ultrasound and fluoroscopic
guidance. Vascular. March 14th.
Use subclavian site rather than a jugular or
femoral site in adult patient to minimize
infection risk for nontunnelled CVC
placement. Cat 1B
For tunneled CVC unresolved issue.
Daily review of line necessity Daily review of line necessity Daily review of line necessity Daily review of line necessity
Menghindari pelepasan kateter yang
tidak perlu
Use a sutureless securement device to
reduce the risk of infection for
intravascular catheters (Cat II)
Use a chlorhexidine impregnated sponge
dressing for temporary short-term
catheters in patients older than 2 months
of age if the CLABSI rate, (Cat 1b)
CHG Impregnated
3/21/2014
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Peripheral Care; Kasa + Plester
Nursing
Labor
Catheter
Skin prep
Dressing ?
Insertion
June 10
8am
June 11
8am
June 12
8am
June 13
8am
24
hours
48
hours
72
hours
+
+
+
Nursing
Labor
Skin prep
Gauze+
Tapes
+
+
Peripheral Care; Tegaderm
Nursing
Labor
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 Cost
Kemungkinan Kateter Lepas
Paramater jaminan sterilisasi
External indikator
Internal indikator
Produktifitas
Memotong kasa membungkus
Tempat Kasa & Pengemas
Proses Sterilisasi
Air dan listrik
Petugas CSSD
Mengoptimalkan fiksasi dg Tegaderm dressing
Pastikan kulit bersih dari kotoran dan kering
Lakukan skin prep dengan alkohol swab (3x
lebih baik) dan pastikan kering
Lakukan penekanan pada permukaan
transparan dressing: hub kateter, sayap dan
permukaan
Lakukan penekanan pada sekeliling pada
saat melepas linernya
Beri tambahan plester pada hub kateter
3M
2007. All
Rights
Contoh applikasi transparan Dressing yang kurang Tepat
3M
2007. All
Rights
Plester tambahan menututupi area monitoring
Contoh applikasi / Practice
3M
2007. All
Rights
Perlu tambahan plester
sekitar sambungan hub
kateter.
Jangan fiksasi kateter
infus dibawah
transparan dressing.
Fiksasi Spalek jangan
menutupi daerah
insersi.
3/21/2014
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3M Critical & Chronic Care Solutions Feature & Benefit
Lebih tipis &
Hipoalergenik
Nyaman & minimal reaksi alergi
Lebih Transparent:
Memudahkan monitoring
tempat tusukan antisipasi
plebitis.
Window delivery system:
Memudahkan pemasangan
Dilengkapi Label:
Menuliskan jam, tgl pemasangan &
nama inisial pemasangnya.
Complete Size Variant
Tersedia berbagai ukuran untuk
pasien bayi-dewasa
Effective & Effisien
Dapat dipasang selama 3hr
mengurangi pergantian dressing
TegadermTransparent I.V.
TM 1623
Catheter Port
Tegaderm Tanpa Plester tambahan
TM 1624
Catheter tanpa
Port
TM 1622
Infus pada Bayi
Tegaderm IV dengan tambahan plester
TM 1610
Infus pada anak
TM 1633 Untuk kateter
Port / lurus
Tegaderm CVC
TM 1626 tanpa plester
tambahan
TM 1635 TM 1655
Border sekeliling
3M 2009. All Rights Reserved.
Dressing Original Frame IV Central Dressing Plus
Transpore
Fiksasi selang infus
Transparan memudahkan untuk
memonitor bila ada emboli,
trombus
Mudah dirobek vertikal atau
horisontal tanpa pemotong
Dapat juga untuk fiksasi Dop
pengaman mata.
3/21/2014
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X
Update News
Satu rol plester untuk
satu orang pasien
jangan di share
Beberapa Study:
74 % of sample taken from
40partial-use rolls had some
bacteria growth (1974)
5 year outbreak of methicilin-
susceptible staphylococus aureus
among 202 babies in a neonatal
unit in which the infection was
related to an adhesive used as a
skin protectant. (Wilcox, et al, 2000)
Tape source of contamination at 3
hospitals in the hunter new England
area health service (Haris, et al
2012).
Skin Damage Associated With Intravenous Therapy:
Common Problems and Strategies for Prevention
Infusion therapy approximately 90% hospital and estimated 1.3 million home
infusion / year
Some experience alterations in skin integrity which are limited published data
associated with infusion therapy, and the etiology of damage has not been
previously described in detail.
In which adhesive wear is a constant and localized, superficial skin damage is
common. This article will offer a WOC nursing perspective of skin damage and
seek to provide a context for understanding and preventing skin damage in the
infusion therapy patient.
3M
2007. All
Rights
Journal of Infusion Nursing: November/December 2012
Volume 35 - Issue 6 - p 390401 doi: 10.1097/NAN.0b013e318270a91e
(Thayer, Debra MS, RN, CWOCN)
Terimakasih
Further Question:
08119003405
dsidik@mmm.com

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