Beruflich Dokumente
Kultur Dokumente
Yunior
Pembimbing :
Dr. Moh. Supriatna TS, SpAK
Dr. Yusrina
Dr. Dewi Ratih, M.Si. Med, SpAK
Oleh : Roro Rukmi Windi
Perdani
INTRODUCTION
Indwelling arterial catheter (IACs) in neonatal & pediatric care
unit
Hemodynamic monitoring & blood sampling purposes
Various location : umbilical artery, ulnar, brachial, axillary,
dorsalis pedia, tibialis posterior, femoral
Different catheter types
Require a high level of technical skill
Cause important complication thrombosis
AIM
Investigate the incidence and predictors of
thrombosis resulting from IACs at different
locations i pediatric population
Management of IACs
2x unseccssful staff
intensivists/anesthesiolo
gists
Verified by X-ray
Not right
Felows in training
positionremoved
Staff intensivists
Different type of
Staff anesthesiologists
catheter
Management of PICU spesific
Flushed byclinical
Saline
solution
w/
1
U/mL
UHF
situationManagement of PICU
at 1-2 mL/h (< 10 kg or
spesific clinical situation > 10 kg)
Removed if no longer
needed/complication
Dysfunction : not able
to flush IAC w/ saline
solution, to aspirate
blood or providing
arterial blood pressure
curve
Femoral arteries : BP
measurment 1x/day,
extrimities palpation
3x/day
Absent pulses, BP
difference of limb > 15-20
mmhg/pale extrimities
doppler USG
Radial artery : pulse
palpation
Umbilical arteriy : skin
color on the back,
periumbilical, & lower
extrimities 6x/day
Persistent elevated BP :
doppler USG
Iv
milrinone
&/or
cathecola
mine
Low
cardiac
output :
cool
extrimities
,
mottled/ci
anotic
skin, low
urin
output,
lactate >
2.0
mmo/L,
central
venous
saturation
< 25%,
ejection
fraction <
55 %
Postoperat
ive
protocol :
bidirection
al Glenn
anastomo
sis, a
Fontan
proscedur
ew
extracardi
ac
conduit,
modified
BlalockTaussig
shunt, etc
Iv milrinone &/or
cathecolamine
Low cardiac
output : cool
extrimities ,
mottled/cianotic
skin, low urin
output, lactate >
2.0 mmo/L, central
venous saturation
< 25%, ejection
fraction < 55 %
Iv milrinone &/or
cathecolamine
STATISTICAL ANALYSIS
Descriptive : frequencies, means, ,median
Differences : one-way ANOVA
Predictors : univariate logistic regression : OR
95% CI
Multiple logistic regression
Signoficance : P<0.05
SPSS version 18, Chicago, IL, USA
RESULT
Patient Population