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"Latar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.Kata kunci: stenosis vena sentral, kateter hemodialisis temporer, akses vaskular

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Background The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter"

"ABSTRAKAbstrakLatar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.

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ABSTRACTBackground The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter, vascular access"

"Pendahuluan: Kateterisasi vena sentral (KVS) adalah sebuah faktor risiko utama untuk terjadinya stenosis vena sentral (SVS). Kontak berulang dari kateter ke dinding pembuluh darah menyebabkan inflamasi, mikrotrombi, hiperplasia intima, fibrosis dan akhirnya stenosis. Artikel ini melaporkan korelasi antara durasi dan frekuensi KVS dengan terjadinya SVS. Metode: Studi kasus kontrol dilakukan di Rumah Sakit CiptoMangunkusumo. Data diambil dari rekam medis tahun 2013 sampai 2015. Hasil: Lima puluh empat dari 717 pasien yang menjalani KVS untuk hemodialisa menderita SVS. 32 pasien dengan SVS menjadi kasus dan 128 tanpa SVS sebagai kontrol. Durasi KVS >6 minggu tidak meningkatkan resiko SVS (p=0,207), rasio odds SVS ditemukan 30 kali pada pasien yang menjalani KVS >2 kali dibandingkan <2 kali (p<0,001). Konklusi: Frekuensi KVS > 2 kali meningkatkan risiko SVS. Durasi >6 minggu tidak meningkatkan risiko SVS.

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Introduction: Central vein catheterization (CVC) is a major risk factor for central vein stenosis (CVS). Repetitive contacts of the CVC to the blood vessel wall results in inflammation, microthrombi, hyperplasia of the intima, fibrosis and thus development of CVS. This article reports the correlation of duration and frequency of CVC in patients with CVS.

Methods: A matched case control study was conducted in CiptoMangunkusumo Hospital. Samples were gathered from the medical record from 2013 to 2015.

Results: Fifty four out of 717 patients underwent CVC for HD had CVS. 32 patients with CVS included in the study with 128 non-CVS patients included as control. Duration of CVC >6 weeks does not increase the risk of CVS (p= 0.207), whilst the odds ratio of CVS on the frequency of CVC >2 times is 30 times compared to those underwent <2 times (p= <0.001).

Conclusion: The frequency of CVC >2 times increased the risk of CVS. Longer duration of CVC for HD did not increase CVS rate."

"Kateter vena sentral (Central Venous Catheter/CVC) digunakan secara luas terhadap pasien dengan kanker, beresiko menyebabkan infeksi primer aliran darah (IPAD) yang berakibat pada meningkatnya morbiditas, lama hari rawat serta biaya operasional dan pengobatan. Penelitian ini menggunakan disain studi potong lintang untuk mengetahui gambaran kejadian IPAD pasien dengan kanker terkait pemasangan CVC (IPAD-CVC) di RS. Kanker “Dharmais” tahun 2011-2012 pada populasi seluruh pasien kanker yang terpasang CVC dan didapatkan 119 sampel yang telah memenuhi kriteria inklusi dan eksklusi. Analisis univariat menunjukkan frekuensi pasien yang mengalami sepsis (18,5%), kolonisasi (47,9%), bakteremia (14,3%) dengan insidens IPAD-CVC (13,3%) banyak terjadi pada pasien dengan jenis keganasan hematologi (78,4%), pada ruang isolasi imunitas menurun (90%). IPAD-CVC banyak dialami oleh pasien kanker dengan rata-rata lama hari rawat > 30 hari dan sebanyak 45,0% disebabkan oleh bakteri gram-negatif. Perilaku asuhan keperawatan pasien dengan kanker termasuk pemasangan CVC, dukungan manejemen dan pengelolaan data surveilens yang lebih baik diperlukan dalam upaya pencegahan dan pengendalian infeksi aliran darah.

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Central venous catheter (CVC) are used extensively in patient with neoplastic disease, and primary bloodstream infection related to CVC (BSI-CVC) increasing morbidity, prolonged hospital stays including operational costs and treatment. Cross-sectional study with all hospitalized patient with an underlying cancer using CVC in periods 2011-2012 to describe primary bloodstream infections related to CVC at “Dharmais” National Cancer Centre year 2011-2012. 119 patients were selected from inclusion and exclusion criteria were eligible for this study. Univariate analysis shows clinical sepsis (18.5%), colonization (47.9%), bacteremia (14.3%) and cumulative incidence of BSI-CVC (13.3%). Most frequent of BSI-CVC are patient with hematology malignancies (78.4%) and higher proportion are patients in the immunocompromised-care (90%) in patients with average of hospital stays are more than 30 days. 45% Gram-negative bacteria’s are responsible to BSI-CVC. Behavior of nursing care against cancer patients with CVC, management support and surveillance data needed to bloodstream infection control and prevention."

"Since their first application in 1982, Totally Implantable Venous Access Devices (TIVADs) have become increasingly important in the clinical practice, as more intensive chemotherapy and parenteral treatments have come into use. At this time, there is objective evidence that TIVADs are a safe, effective strategy for long-term venous access; they play a significant role throughout the management of the oncology patient, as they are needed in the initial phases for active treatments as well as in the last stages for palliative measures, making possible repeated administration of chemotherapeutic vesicant agents, nutrients, antibiotics, analgesics, and blood products. According to a number of prospective studies, use of TIVADs is associated with a significant complication rate (10% to 25% of all patients). Evidence-based data support that most complications are directly related to inappropriate technique of placement and/or nursing care, sometimes leading to TIVAD loss, significant morbidity, increased duration of hospitalization, and additional medical cost."

"ABSTRAK Latar belakangModalitas akses vaskular yang sering digunakan untuk melakukan tindakan HD pada anak adalah penggunaan tunneled double lumen catheter TDLC , yang telah meningkat penggunaannya dari 60 pada tahun 2011 sampai 78 pada tahun 2014 dari semua pilihan akses vaskuler untunneled catheter, tunneled catheter, AVF dan AVG . Belum ada data mengenai lama penggunaan kateter tersebut berhubungan dengan posisi pemasangan, lokasi ujung kateter, bakteremia yang berhubungan dengan kateter, dan status nutrisi. Penelitian ini bertujuan untuk menelaah faktor-faktor yang memengaruhi lama penggunaan kateter tersebut.MetodeStudi deskriptif dengan desain cross sectional dengan subjek penelitian anak berusia 2-18 tahun dan menderita penyakit ginjal kronik stadium 4-5 yang menjalani HD reguler di RSCM. Data berasal dari rekam medis. Berdasarkan data dari registrasi pasien didapatkan terdapat 70 pasien anak yang dipasang TLDC antara bulan Agustus 2012 sampai Agustus 2016. Semua kateter yang dipasang adalah Hemo-Cath LT diproduksi oleh Medcomp , Harleysville, PA, USA . Lima belas pasien dieksklusi karena data yang tidak lengkap. Sehingga didapatkan 55 pasien yang masuk kriteria inklusi. Analisis statistik dengan uji statistik Mann-Whitney, Kruskall-Wallis, regresi linear. Pengujian dilakukan dengan menggunakan piranti lunak SPSS version 20 for Windows.HasilSelama periode Agustus 2012 sampai Agustus 2016 didapatkan 55 subjek yang memenuhi kriteria; 32 subjek 58,2 laki laki dan 23 subjek 41,8 perempuan. Rerata lama penggunaan TDLC 125 hari. Lama penggunaan TDLC pada kelompok posisi ujung kateter di mid atrium lebih panjang dibandingkan pada kelompok posisi ujung kateter di luar mid atrium kanan 154 20-491 hari vs 86,5 35-228 hari;

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ABSTRACT

BackgroundThe most common vascular access used for hemodialysis HD in children is tunneled double lumen catheter TDLC . The use of TDLC increased from 60 in 2011 to 78 in 2014 among all vascular access options untunneled catheter, tunneled cathteter, arteriovenous fistula AVF and arteriovenous graft AVG . There is no data about duration of catheter use associated with site of insertion, tip position, catheter related bacteremia, nutritional status and underlying disease. The study aimed to find out factors influencing the duration of catheter use.MethodA cross sectional descriptive study was carried out enrolling subjects of 2 18 years old with stage 4 5 chronic kidney disease undergoing regular HD in Cipto Mangunkusumo Hospital since August 2012 until August 2016. Data was collected from patients rsquo medical records at RSCM medical records department. Informations gathered included age, sex, weight, height, duration of TDLC use, site of insertion, catheter tip position based on plain thoracic photo, history of diagnosis of catheter related bacteremia, and primary disease.Review of the procedural databese for TDLC placement on pediactrics patient revealed 70 patients between August 2012 and August 2016. All of catheters were Hemo Cath LT Manufactured by Medcomp , Harleysville, PA, USA . fifteen patiens were excluded because of incomplete medical records. Therefore, the study consisted of 55 patients. Statistical analysis was performed using Mann Whitney, Kruskall Wallis, and linear regression with SPSS version 20 for windows.ResultIn period of August 2012 until August 2016 there were 55 subjects who met the criteria 32 subjects 58.2 were males and 23 subjects 41.8 were females. Median duration of catheter use was 125 days. Duration of catheter use with the tip position in the mid atrium group is longer than in those higher than mid right atrium superior vena cava 154 20 491 days vs. 86.5 35 228 days p"