PLEBITIS
Oleh
Himpunan Perawat Pencegah dan Pengendali Infeksi Indonesia
( HIPPII)
Pengertian
Jika infeksi :
Kemerahan, demam, sakit, bengkak,
adanya pus atau kerusakan pada kulit
Patofisiologi
Faktor etiologi plebitis
(spontan, komplikasi , p’sangan infus) Tidak diatasi
Pengaruh
penurun Terbentuknya Inflammatory
histamine, Menyebabkan faktor continued
bradikinin, dan Kerusakan dan procoagulan di
serotonin iritasi PB endothelial
Mengaktifasi A thrombus
Permeabilitas ‘ll form in
proacugulan
Nyeri kapiler me ↑ vein
Edema dan
tenderness Hipertermia
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
Agent infeksius
Catheter Related Infection Risk
Contaminated
Infusate
4
IV site
• With or without edema
• Remove IV and culture site and catheter
• Streak formation tip
• Palpable venous cord > 1 inch • Notify primary service
• Purulent drainage
Infiltration Scale (INS 2006)
No symptoms 0
• Skin blanched
• Edema < 1 inch in any direction
• Cool to touch 1
• With or without pain
• Skin blanched
• Edema 1 – 6 inches in any direction
• Cool to touch 2
• With or without pain
1.Plebitis Kimia
2. Plebitis Mekanis
3. Plebitis Bakterial
1.Plebitis Kimia
pH dan osmolaritas cairan infus yang ekstrem pH ↓,
osmolaritas ↑
1.HAND HYGIENE
2. PREPARASI KULIT
Process - 2 Steps
Apply alcohol in circular motion outwards, allow it to dry
Apply Povidone Iodine or Chlorhexidine in circular motion
outwards, allow it to dry
3. DRESSING / PENUTUP INFUS
CDC, Centre for Disease Control and Prevention, Guidelines for prevention of Intravascular 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 contact 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 administration 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
8% Syringes prepared by nurses are contaminated - Syringe tip, Fluid***
Touch contamination
Multiple use vials or their inappropriate usage
page 394, ** CDC, Centre for Disease Control and Prevention, Guidelines for prevention of IV catheter related Infections, MMWR, 2002: 51, Page 9 ( No. RR 10 ), ** APIC, Lynn
Hadaway, Webinar series 2006
Infusion Therapy in clinical practice Judy Hankins et al, 2nd Edition, The Infusion Nursing Society,
5. Appropriate use of equipment
1. Intravasular Access
3.IVD replacement
Peripheral Venous : 72-96 hrs in adults / first signs of phlebitis,
In pediatric patients, Do not routinely replace peripheral venous
catheters unless clinically indicated
CVC’s / PICC / Hemodialysis / PA / Peripheral Arterial : NOT routinely*
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
NHS
• Pengumpulan data setiap hari
• Perhitungan setiap bulan
• Laporan setiap bulan,triwulan,semester, tahunan
• Insiden rate Plebitis:
Jumlah plebitis
--------------------------------- X 1000 = (‰)
Hari pemakaian IV Kateter
Himpunan Perawat Pencegah dan
30
Pengendali Infeksi Indonesia (HIPPII)- Pusat