DASAR PEMASANGAN
KATETER VENA SENTRAL
Arif Mansjoer
Cardiac ICU Pelayanan Jantung Terpadu RSCM
Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM
Curriculum Vittae
• Nama : Arif Mansjoer
• Pendidikan :
• 1999 Dokter Umum FKUI
• 2005 Spesialis Penyakit Dalam FKUI
• 2008 Konsultan Intensive Care FKUI
• 2014 Magister Epidemiologi, FKM UI
• 2017 Konsultan Kardiovaskular, FKUI
• Pekerjaan :
• Cardiac Intensive Care Unit Pelayanan Jantung Terpadu RSCM
• Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM
• Intensive Care Unit, RS Jantung Jakarta
Kompetensi
Pemasangan Kateter Vena Sentral
• Anatomi vena
• Indikasi
• Manfaat
• Kontraindikasi
• Komplikasi pemasangan
• Komplikasi penggunaan jangka Panjang
• Cara mencegah infeksi nosokomial
Anatomi
• Vena Jugularis Interna
• Vena Subklavia
• Vena Femoralis
Anatomi: v. jugularis interna
Anatomi: v. jugularis interna
V. jugularis interna: Anatomical landmark
V. jugularis interna: Anatomical landmark
V. Jugularis interna: Central approach
V. Jugularis interna: Anterior approach
V. Jugularis interna: Posterior approach
Anatomi: v. subklavia
V. subklavia: Infraclavicular approach
V. subklavia: Infraclavicular approach
V. subklavia: supraclavicular approach
Anatomi: v. femoralis
Anatomi: v. femoralis
Tanpa Dengan
Nutrisi parenteral
Elektrolit pekat
Inotropik/ vasoaktif
Penilaian tekanan darah
Pengambilan sampel darah rutin,
ScVO2, dan SvO2 (mixed vein)
Akses terapi pengganti ginjal
Non-tunneled
• Hemodialisis
• SLEDD
• CRRT
Tunnele
Akses pacu jantung
permanen
temporar
Kontraindikasi
1. Pasien gaduh gelisah, delirium, atau
tidak kooperatif
2. Area insersi mengalami infeksi atau luka bakar
3. Kelainan anatomi: kurus, gemuk, riwayat radiasi
4. Gangguan hemostasis: trombosis,
DIC, penggunaan terapi antikoagulan
5. Pascaprosedur: mastektomi, tiroidektomi,
AV shunt
Indikasi Pemasangan Akses
1. Pemasangan akses vena perifer yang sukar
2. Pemberian cairan osmolaritas tinggi atau pekat
dan obat khusus:
• Cairan dengan, seperti nutrisi parenteral, elektrolit pekat
• Obat kemoterapi
• inotropik, vasopresor, vasodilator
3. Pengukuran CVP, RAP, RVP, PAP, PCWP
4. Pengambilan darah untuk menilai ScvO2 atau SvO2
5. Pemasangan akses terapi pengganti ginjal
baik hemodialisis intermiten atau CRRT
6. Pemasangan akses pacu jantung dan
intervensi jantung
Komplikasi
Komplikasi V.jugularis interna V.subklavia V.femoralis
Pungsi arteri 3% 0,5 % 6,25 %
Hematoma < 0,1 – 2,2 % 1,2 – 2,1 % 3,8 – 4,4 %
Hemototoraks Tidak ada 0,4 – 0,6 % Tidak ada
Pneumotoraks < 0,1 – 0,2 % 1,5 – 3,1 % Tidak ada
Malposisi Risiko ringan (masuk Risiko tinggi Risiko rendah
ke vena kava inferior (melewati v (mengenai pleksus
melalui atrium kanan) subklavia vena lumbal)
kontralateral, naik v
jugularis interna)
Trombosis 1,2 – 3/1000 hari 0 - 13 /1000 hari 8 - 34 /1000 hari
kateter kateter kateter
Infeksi 8,6 /1000 hari 4 /1000 hari 15,3 /1000 hari
kateter kateter kateter
Komplikasi
Saat pemasangan Setelah pemasangan
1. Nyeri 1. Infeksi
2. Perdarahan 2. Trombosis
3. Pneumotoraks
4. Emboli udara
5. Aritmia
Pencegahan Infeksi Nosokomial
Selection of Catheters and Sites
1. Weigh the risks and benefits of placing a central
venous device at a recommended site to
reduce infectious complications against the risk
for mechanical complications Category IA
2. Avoid using the femoral vein for central
venous access in adult patients. Category 1A
3. Use a subclavian site, rather than a jugular or a
femoral site, in adult patients to minimize
infection risk for nontunneled CVC
placement. Category IB
Selection of Catheters and Sites
4. No recommendation can be made for a preferred
site of insertion to minimize infection risk for a
tunneled CVC. Unresolved issue
5. Avoid the subclavian site in hemodialysis patients
and patients with advanced kidney disease, to
avoid subclavian vein stenosis. Category IA
6. Use a fistula or graft in patients with chronic renal
failure instead of a CVC for permanent access
for dialysis. Category 1A
7. Use ultrasound guidance to place central venous
catheters (if this technology is available) to reduce
the number of cannulation attempts andmechanical
complications. Ultrasound guidance should only be
used by those fully trained in its technique.
Category 1B
Selection of Catheters and Sites
8. Use a CVC with the minimum number of ports or
lumens essential for the management of the
patient. Category IB
9. No recommendation can be made regarding the use
of a designated lumen for parenteral nutrition.
Unresolved issue
10. Promptly remove any intravascular catheter that is
no longer essential. Category IA
11. When adherence to aseptic technique cannot be
ensured (i.e catheters inserted during a medical
emergency), replace the catheter as soon as
possible, i.e, within 48 hours. Category IB
Terima kasih
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