Terapi

INTRAVENA
Alfrina Hany

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 OUTLINE

Definisi & Indikasi

Jenis injeksi
Cara melakukan injeksi
Alat yang digunakan
Prosedur keamanan
Cara melakukan Flebotomi & infus yang
benar

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 Definisi

Prosedur invasif yang banyak dilakukan

di RS
Memasukkan kateter ke dalam
pembuluh darah dengan tujuan tertentu

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 Tujuan
Nutrisi parenteral
Dialisis
Transfusi darah/plasma/dll
hemodynamic monitoring
diagnostic testing
Resusitasi cairan dan obat.

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 Jenis Injeksi

Intra vena : Perifer dan sentral

Lain : Intra vena, intra dermal,
Intramuskular, subkutan

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 Cara melakukan injeksi

Persiapan alat
Persiapan klien
Persiapan dokter/perawat
Pemilihan lokasi
Tindakan injeksi
Evaluasi respon klien & komplikasi

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 Persiapan klien

Kaji pengetahuan klien

Beritahukan tujuan
Minta klien bekerjasama

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 Persiapan Anda :
Prosedur keamanan
Universal precaution : cuci tangan
Standar precaution : sarung tangan,
masker, scort, google
Infeksi : sampah medis, kontainer
benda tajam, alat disposible

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 PERSIAPAN ALAT INJEKSI

Spuit/syringe : ukuran sesuai

kebutuhan
Sarung tangan
Turniket
Alkohol swab
Alas perlak

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 Pemilihan lokasi
Sangat menentukan keberhasilan
FEEL IT, Sight is not enough
Penekanan diperlukan
Hindari area sendi fleksi
Mulai area distal dulu menuju proksimal
Gunakan sarung tangan
Tidak ditepuk2

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 Veins of the Upper Extremities

Digitalis
-sepanjang lateral jari, mudah nyeri,
sulit untuk mobilisasi

Metacarpal
-Lokasi antara sendi dan tulang
metacarpal Digital
-Terbentuk dari banyak vena digitalis
-Pasien Geriatric : turgor kulit dan
jaringan adiposanya sudah tidak baik

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 Veins of the Upper Extremities

Cephalic
-Mulai radialis pergelangan tangan
-Akses sepanjang tangan (hati2
arteri/saraf radialis)

Medial Cephalic
- Tepat di bawah sendi pada lengan
- Bisa memakai kateter yang ukuran
besar

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 Veins of the Upper Extremities
Basilica
- Originates from the ulner side of
the metacarpal veins and runs
along the medial aspect of the arm.
It is often overlooked becauses of
its location on the back of the
arm, but flexing the elbow/bending
the arm brings this vein into view

Medial Basilic
- Empties into the Basilic vein
running parallel to tendons, so it is
not always well defined. Accepts
larger gauge catheters.
- BEWARE of Brachial Artery/Nerve
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 Tindakan Injeksi
Gunakan sarung tangan.
Pasang turniket
Desinfeksi
Masukkan jarum dengan sudut 30
Penanda darah pada ujung tabung
Aspirasi
Masukkan cairan/ambil spesimen
Ambil kapas alkohol
Tekan kapas pada lokasi insersi sambil mencabut
jarum
Evaluasi respon klien

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 PERSIAPAN ALAT INFUS

Cairan infus
Venflon/abocath
Selang infus
Kasa steril/veca-C
Plester
Jam tangan detik
Tiang infus

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 Venflon

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 Tindakan infus

Siapkan cairan pada tiang

Siapkan selang infus
Pilih lokasi
Pasang turniket
Pasang sarung tangan
Masukkan jarum
lihat penanda darah

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 Tindakan infus
Tarik sedikit jarum dari kanul perlahan
Masukkan kanul ke dalam vena
Fiksasi dan s iapkan selang
Tarik jarum seluruhnya
Sambungkan kanul dengan selang
Buka selang infus
Pasang balutan
Hitung tetesan infus

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 The IV Fluid Supermarket
Crystalloids Colloids
Dextrose in water
Albumin
D5W
5% in NS
D10W
D50W 25% (Salt Poor)
Saline Dextrans
Isotonic (0.9% or normal) Hetastarch
Hypotonic (0.45%, 0.25%)
Hypertonic
Blood
Combo
D51/2NS
D5NS
D10NS
Ringers lactate physiologic.
(K, HCO3, Mg, Ca)

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 Persiapan alat Vacutainer

Holder
Tabung
Syringe
Alcohol swab
kasa

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 Tabung

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 Tindakan Vacutainer

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 Tindakan Vacutainer

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 Potential Complications

Sepsis (infection) Catheter fragment

Hematoma embolism
Cellulitis Infiltration

Thrombosis Air embolism

Phlebitis

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 Infiltration/Extravasation
The most common cause is damage to the
wall during insertion or angle of placement.

STOP INFUSION and treat

as indicated by Pharmacy,
Medication package insert
or drug reference book.

Notify MD and document

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 Phlebitis/Thrombophlebitis
Chemical
- Infusate chemically erodes
internal layers. Warm compresses may
help while the infusate is
stopped/changed. Anti-inflammatory
and analgesic medications are often
used no matter what the cause
Mechanical Bacterial
- Caused by irritation to - Caused by introduction of
internal lumen of vein during insertion bacteria into the vein. Remove the
of vascular access device and usually device immediately and treat
appears shortly after insertion. The w/antibiotics. The arm will be
device may need to be removed and painful, red and warm; edema may
warm compresses applied accompany

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 Cellulitis

Inflammation of loose connective

tissue around insertion site.
- Caused by poor insertion technique
- Red swollen area spreads from
insertion site outwardly in a diffuse circular
pattern
- Treated w/antibiotics

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 Septicemia/Pulmonary Edema/
Embolism
Septicemia
- Severe infection that occurs to a system or entire body
- Most often caused by poor insertion technique or poor site care
- Discontinue device immediately, culture and treat appropriately

Pulmonary edema- caused by rapid infusion

Pulmonary embolism - Caused by any free floating substances that
require thrombolytic therapy for several months. Increased risk w/lower ext.

Air embolism- caused by air injected into IV system. Keep insertion site
below level of heart

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 Demonstration & Practice
Questions?

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