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"Latar Belakang: Secara insidensi, statistik akses vaskular di pada tahun 2009 di Amerika Serikat adalah: 81,8% dengan kateter vena sentral (CVC). KDOQI juga menyarankan pengunaan non cuffed catheter untuk jangka waktu sementara (<2 minggu), namun pada kenyataan nya di Indonesia, masih banyak penderita HD yang menggunakan non cuffed catheter >2 minggu. Metode: Desain penelitian yang digunakan adalah desain kohort historikal. Penelitian dilakukan di Rekam Medis Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo, Jakarta periode Januari 2021 sampai dengan November 2023. Dilakukan uji bivariat dan multivariat pada data yang didapat. Hasil: didapatkan 262 sampel penelitian dengan 39 (14.9%) sampel yang mengalami CRBSI dan 223 (85.1%) sampel yang tidak mengalami CRBSI. Variabel yang meningkatkan risiko terjadinya CRBSI adalah durasi pemasangan kateter >2 minggu (p < 0,001), durasi rawat inap >7 hari (p < 0,001) , lokasi kateter di femoral (p = 0,005), dan lokasi tindakan bedside (p < 0,001). Dari uji multivariat didapatkan durasi pemasangan kateter >2 minggu memiliki peningkatan risiko mengalami CRBSI sebesar 14 kali lipat dibanding durasi  2 minggu. Durasi rawat inap >7 hari memiliki risiko 71 kali lipat mengalami CRBSI dibanding durasi  7 hari. Lokasi kateter di femoral memiliki peningkatan risiko mengalami CRBSI sebesar 10 kali lipat dibanding lokasi di jugular. Lokasi tindakan bedside memiliki peningkatan risiko mengalami CRBSI sebesar 54 kali lipat disbanding tindakan di ruang operasi. Kesimpulan: Angka kejadian CRBSI pada penderita yang menjalani hemodialisa dengan non-cuffed catheter durasi ≤2 minggu secara bermakna lebih rendah dibandingkan durasi >2 minggu. Faktor yang mempengaruhi kejadian CRBSI pada penderita yang menjalani hemodialisa dengan non-cuffed catheter adalah lokasi tindakan pada bedside, lokasi pemasangan kateter pada vena femoralis, dan lamanya rawat inap >7 hari.

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Backgrounds: In terms of incidence, vascular access statistics in 2009 in the United States were: 81.8% with central venous catheters (CVC). KDOQI also recommends using non-cuffed catheters for a temporary period (<2 weeks), but in reality in Indonesia, there are still many HD sufferers who use non-cuffed catheters for >2 weeks. Methods: The research design used was a historical cohort design. The research was conducted in the Medical Records of the National Central General Hospital, dr. Cipto Mangunkusumo, Jakarta for the period January 2021 to November 2023. Bivariate and multivariate tests were carried out on the data obtained. Results: There were 262 samples with 39 (14.9%) samples with CRBSI and 223 (85.1%) samples without CRBSI. Variables that increase the risk of CRBSI are duration of catheter placement >2 weeks (p < 0.001), duration of hospitalization >7 days (p < 0.001), femoral catheter location (p = 0.005), and bedside procedure location (p < 0.001) . From the multivariate test, it was found that a duration of catheter placement >2 weeks had an increased risk of experiencing CRBSI by 14 times compared to a duration of 2 weeks. A duration of hospitalization >7 days has a 71 times greater risk of having CRBSI than a duration of 7 days. Femoral catheter locations have increased risk of having CRBSI by 10 times compared to jugular locations. Bedside procedures have increased risk of having CRBSI by 54 times compared to procedures in the operating room. Conclusion: The incidence of CRBSI in patients undergoing hemodialysis with a noncuffed catheter for a duration of ≤2 weeks is significantly lower than for a duration of >2 weeks. Factors that influence the incidence of CRBSI in patients undergoing hemodialysis with a non-cuffed catheter are the location of the procedure at the bedside, the location of the catheter in the femoral vein, and the length of stay >7 days."

"Pendahuluan: KDOQI menyebutkan infeksi adalah komplikasi utama terkait penggunaan kateter akses hemodialisis jangka panjang. KDOQI merekomendasikan pemasangan kateter vena tunneling (TCC) hemodialisis pada vena jugularis interna (VJI) kanan dengan posisi ujung TCC ditempatkan di atrium kanan dan bukaan lumen arteri menghadap ke mediastinum. Berdasarkan penelitian yang dilakukan angka catheter related bacteremia (CRB) sebesar 35% pada pemakaian 3 bulan dan 54% untuk pemakaian 6 bulan. Posisi ujung TCC akses hemodialisis VJI kiri mempunyai pengaruh terhadap kejadian disfungsi dan infeksi dibandingkan jika terpasang di sisi kanan.Metode: Dilakukan studi cross sectional dengan 62 subjek pasien hemodialisis menggunakan akses TCC VJI. Dicari hubungan antara posisi pemasangan TCC, posisi ujung TCC dan faktor risiko dengan kejadian terduga CRB menggunakan uji Chi Square dengan nilai p<0,05 dianggap bermakna secara statistik dan penghitungan odd ratio (OR) interval kepercayaan 95%. Diambil data posisi pemasangan TCC, posisi ujung TCC, terduga CRB serta karakteristik berupa usia, jenis kelamin serta status DM di RSCM Januari 2018 sampai Januari 2019.Hasil: Enam puluh dua subjek yang dilibatkan dalam penelitian ini 45 orang (72,6%) berusia 60 tahun kebawah. Empat puluh satu subjek (66,1%) berjenis kelamin pria. Lima belas subjek menderita DM (24,2%). Posisi ujung TCC yang didapatkan dari 62 subjek tersebut, 39 (62,9%) berada di VKS, 2 (3,2%) pada CAJdan 21 (33,9%) pada atrium kanan. Dari 62 subjek tersebut 22 (35,48%) diantaranya mengalami kejadian terduga CRB. Tidak didapatkan hubungan yang bermakna antara posisi ujung TCC VJI dengan kejadian terduga CRB (p = 0,92, OR 1,05 dengan IK 95% = 0,35 – 3,08). Usia, jenis kelamin, dan status DM tidak merupakan faktor risiko bermakna secara statistik berhubungan dengan kejadian terduga CRB.Kesimpulan: Studi ini mendapatkan hasil tidak ada hubungan kemaknaan posisi ujung TCC dan faktor risiko diteliti dengan kejadian terduga CRB.

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Introduction: KDOQI stated infection is the main complication of long-term catheter use as hemodialysis access. KDOQI recommends insertion of tunneling venous hemodialysis catheter in the right internal jugular vein (IJV) with the tip placed in the right atrium and the arterial lumen opening facing the mediastinum. Previous study stated that the number of catheter related bacteremia (CRB) is 35% at 3 months use and 54% at 6 months use. The TCC tip position as hemodialysis access in left IJV is correlated more to dysfunction and infection compared to the right IJV.

Method: A cross-sectional study was conducted with 62 subjects of hemodialysis patients using IJV TCC access. The correlation between TCC insertion location, TCC tip position, and risk factors with suspected CRB was analyzed using Chi Square Test. A p value <0.05 was considered statistically significant. The odds ratio (OR) with 95% confidence interval was analyzed. The data of TCC insertion location, TCC tip position, suspected CRB incidence, and subject’s characteristics including age, sex, and DM status were gathered in RSCM from January 2018 to January 2019.

Results: Within 62 subjects included in this study 45 (72,6%) were 60 y.o or less. Forty one (66,1%) subjects were male. Fifteen had DM as comorbid (24,2%). Thirty nine TCC tip position were in SVC (62,9%), 2 were in CAJ (3,2%) and 21 were in (33,9%)RA. Twenty two from 62 had suspected CRB (35,48%). There is no significant correlation between TCC tip position with suspected CRB incidence (p

= 0.92, OR 1,05, 95% CI = 0.35 – 3.08). Age, sex, and DM status were not statistically proven as risk factors of suspected CRB.

Conclusion: There is no significant correlation between TCC tip position and studied risk factors with suspected CRB."

"[ABSTRAKTujuan : Untuk menentukan apakah PICC dan PIVC pada bayi berat lahir sangat rendah berbeda, yang merujuk pada: kejadian sepsis, Jumlah pemakaian kateter yang dibutuhkan untuk keseluruhan terapi intravena dan efisiensi biaya pemasangan akses vena. Metoda: desain potong lintang retrospektif terhadap rekam medis semua bayi dengan berat lahir sangat rendah yang mendapatkan akses vena di divisi neonatologi RSCM periode tahun 2012 - 2014. Hasil: terdapat 161 kelompok PICC dan 154 kelompok PIVC. Karakteristik kedua kelompok tidak didapatkan perbedaan yang signifikan (p > 0,05). Terdapat perbedaan yang signifikan antara 2 kelompok untuk jumlah pemakaian (p=0,000). Biaya yang dibutuhkan untuk pemasangan kateter berbeda bermakna pada kedua kelompok (p<0,28). Kejadian infeksi aliran darah lebih tinggi pada kelompok PIVC. Beberapa bayi memiliki lebih dari satu episode sepsis, terdapat perbedaan yang signifikan (p = .032). Simpulan: PICC lebih efektif dan efisien dibandingkan PIVC.

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ABSTRACTBackground: To determine whether the PICC and PIVC in low birth weight infants differ on: the incidence of sepsis, the amount of catheter needed for the overall intravenous therapy, IV and the efficiency of cost on installation venous access. Methods: A cross-sectional retrospective design of the medical records of all infants with very low birth weight who gain venous access in neonatology division RSCM period 2012 to 2014. The comparison of proportions between groups were analyzed with SPSS of which P value <0.05 was considered statistically significant. Results: Characteristics of the two groups was not found significantly differences (p> 0.05). There are significant differences between the 2 groups for the number and the duration of the use (p = 0.000), the cost required for catheter (p <0.28) and the incidence of bloodstream infections was higher in the group PIVC. Some babies have more than one episode of sepsis, which are significantly different (p = .032). Conclusion: PICC is more effective and efficient then PIVC. , Background: To determine whether the PICC and PIVC in low birth weight infants differ on: the incidence of sepsis, the amount of catheter needed for the overall intravenous therapy, IV and the efficiency of cost on installation venous access. Methods: A cross-sectional retrospective design of the medical records of all infants with very low birth weight who gain venous access in neonatology division RSCM period 2012 to 2014. The comparison of proportions between groups were analyzed with SPSS of which P value <0.05 was considered statistically significant. Results: Characteristics of the two groups was not found significantly differences (p> 0.05). There are significant differences between the 2 groups for the number and the duration of the use (p = 0.000), the cost required for catheter (p <0.28) and the incidence of bloodstream infections was higher in the group PIVC. Some babies have more than one episode of sepsis, which are significantly different (p = .032). Conclusion: PICC is more effective and efficient then PIVC. ]"

"Analisis praktik residensi keperawatan medikal bedah ini merupakan karya akhir ners spesialis. Analisis praktik residensi ini bertujuan memberikan gambaran pelaksanaan praktik resiensi, terutama pengelolaan berbagai kasus neurologi. Analisis ini terdiri dari kasus kelolaan utama menggunakan pendekatan model adaptasi Roy, penerapan evidence based nursing (EBN) dan proyek inovasi. Kasus kelolaan utama pada laporan ini adalah adenoma hipofisis. Pada kasus kelolaan diagnosa keperawatan diantaranya gangguan mobilitas fisik, Risiko ketidak efektifan perfusi serebral teratasi, dan pada 30 kasus resume diagnose terbanyak yaitu penurunan kapasitas adaptif intrakranial dan nyeri akut. Penerapan EBN yang dilakukan pada praktik residensi ini adalah tentang early removal catheter pada pasien paska kraniotomi, dan terbukti dapat menurunkan length of stay pasien paska kraniotomi. Pada praktik residensi ini residen juga menerapkan proyek inovasi dalam meningkatkan pengetahuan perawat untuk melakukan asuhan keperawatan pada pasien dengan pembedahan spinal, hasil penerapan inovasi ini menunjukkan terjadinya peningkatan pengetahuan perawat terkait asuhan keperawatan perioperative pada pasien pembedahan spinal. Banyak manfaat yang didapatkan dari praktik residensi yang telah dilakukan diantaranya latihan critical thinking dalam mengelola kasus sulit, melatih kemampuan kolaborasi dengan tenaga kesehatan lainnya, menerapkan asuhan keperawatan berbasis bukti. Perawat neurosains dapat menerapkan EBN dalam setiap intervensi keperawatan yang dilakukan, melatih kemampuan berfikir kritis dan kemampuan kolaborasi dengan tenaga kesehatan yang lainnya, sehingga kepuasan pasien terhadap pelayanan keperawatan semakin meningkat.

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This analysis of medical surgical nursing residency practice is the final work of specialist nurses. This residency practice analysis aims to provide an overview of the practice of residency, especially the management of various neurological cases. This analysis consists of the main managed cases using Roy's adaptation model approach, the application of evidence-based nursing (EBN), and the innovation project. In cases managed, nursing diagnoses included impaired physical mobility, the risk of ineffective cerebral perfusion was resolved, and in 30 cases the most resumed diagnoses were decreased intrakranial adaptive capacity and acute pain. The application of EBN in this residency practice is about early catheter removal in post-craniotomy patients and has been shown to reduce the length of stay of post-craniotomy patients. In this residency practice, the resident also implemented an innovation project in increasing the knowledge of nurses to perform nursing care for patients with spinal surgery, the results of the application of this innovation showed an increase in nurses' knowledge regarding perioperative nursing care for spinal surgery patients. Many benefits have been obtained from the residency practice that has been carried out including critical thinking exercises in managing difficult cases, training in collaboration skills with other health teams, and implementation of evidence-based nursing care. It is expected for nurses, especially neuroscience nurses using EBN in every nursing intervention carried out, and practice critical thinking skills and collaboration skills with other health teams, so that patient satisfaction with nursing services will increase."

"Latar belakang: Seorang neurointervensionis untuk melakukan Tindakan neuroendovaskular harus mengetahui pasti struktur karotis dan serebrovaskular, hal ini menentukan keberhasilan tindakan. Bentuk dan perubahan anatomi pembuluh darah menentukan jenis kateter yang digunakan dalam intervensi diagnostik maupun terapetik. Keadaan anatomi yang berbeda-beda dipengaruhi beberapa faktor seperti jenis kelamin, usia, dan kondisi komorbid. Tujuan penelitian ini untuk menentukan faktor predisposisi yang ada, dan dapat memprediksi jenis kateter yang tepat untuk digunakan. Metode: Penelitian deskriptif analitik dengan 57 sampel, dilakukan di Cathlab Pusat Jantung Terpadu (PJT) Rumah Sakit Pusat Nasional Dr. Cipto Mangunkusumo dari Desember 2018 sampai Desember 2021. Faktor-faktor predisposisi dan kondisi komorbid diukur pada setiap pasien. Analisis data dilakukan secara bivariat dan multivariat. Hasil: Variasi lengkung aorta tipe I berjumlah 38, tipe II berjumlah 9 dan tipe III berjumlah 10. Analisis bivariat menunjukkan usia (p<0,001), jenis kelamin (p=0,256), hipertensi (p=0,089), diabetes melitus (p=0,179), riwayat strok (p=0,882), obesitas (p=0,455), kelainan pembuluh darah intrakranial (p=0,608), letak percabangan arteri karotis komunis (p=0,069), jenis kateter yang digunakan (p=0,425). Analisis multivariat menunjukkan (p=0,026; R2=43%) dengan model usia yang menentukan jenis kateter (p=0,015). Simpulan: Usia adalah faktor prediktor yang dapat memprediksi pemilihan jenis kateter pada pemeriksaan diagnostik maupun terapeutik pasien.

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Background: A neurointerventionist to perform neuroendovascular procedures must know for sure the carotid and cerebrovascular structures. Anatomically, this determines the success of the action. Anatomical changes determine the type of catheter used in diagnostic and therapeutic interventions. Different anatomical conditions are influenced by several factors. The purpose of this study was to determine the predisposing factors that can predict the type of catheter used.

Methods: Analytical descriptive study with 57 patients, conducted at the Cathlab Center in Dr. National Central Hospital Cipto Mangunkusumo from December 2018 to December 2021. Predisposing factors were measured for each patient. Data analysis was done by bivariate and multivariate.

Results: The aortic arch variations of type I were 38, type II was 9 and type III was 10. Bivariate analysis showed age (p<0.001), sex (p=0.256), hypertension (p=0.089), diabetes mellitus (p= 0.179), history of stroke (p=0.882), obesity (p=0.455), intracranial blood vessel abnormalities (p=0.608), location of the branching of the common carotid artery (p=0.069), type of catheter used (p=0.425). Multivariate analysis showed (p=0.026; R2=43%) with the age model determining the type of catheter (p=0.015).

Conclusion: Age is a predictor factor that can predict the choice of catheter type in diagnostic and therapeutic examinations of patients."

"Latar Belakang : Efusi pleura masif merupakan salah satu masalah pada tatalaksana kanker paru dan menyebabkan kematian. Pemasangan kateter intrapleura merupakan tatalaksana utama keganasan dengan efusi pleura masif. Kateter yang digunakan yaitu water sealed drainage, indwelling pleural catheter atau pigtail catheter. Water sealed drainage saat ini merupakan kateter yang terbanyak digunakan.Tujuan : Penelitian ini adalah penelitian pendahuluan untuk mengetahui penggunaan (toleransi dan efikasi) water sealed drainage, indwelling pleural catheter dan pigtail catheter pada penatalaksanaan kanker paru dengan efusi pleura masif.Metode : Penelitian observasional kohort retrospektif pada pasien kanker paru tegak jenis dengan efusi pleura masif yang terpasang kateter intrapleura (WSD, IPC atau pigtail catheter). Data diambil dari rekam medis Rumah Sakit Umum Pusat Persahabatan Jakarta pada periode 1 Januari 2012 sampai 31 Desember 2015 dan dilakukan penilaian tolerasi (komplikasi akut dan lanjut) dan efikasi (lama penggunaan, lama rawat dan alasan pencabutan) pemasangan kateter intrapleura.Hasil : Subjek penelitian 77 pasien dengan karakteristik laki-laki (55,8%), median usia 57 tahun, range 26-84 tahun, adenokarsinoma (84,4%) dan terapi kemoterapi (32,5%). Komplikasi akut sebesar 70,1%, komplikasi terbanyak nyeri lokasi pemasangan kateter (58,4%). Komplikasi lanjut sebesar 54,5%, komplikasi terbanyak nyeri lokasi kateter bertambah atau menetap (29,9%). Rerata lama rawat pasca pemasangan kateter 14,14 hari, median 10 hari dan range 1-72 hari. Rerata lama pemakaian kateter 55,98 hari, median 30 hari dan range 2-310 hari. Alasan pencabutan kateter terbanyak adalah produksi cairan minimal (46,75%).Kesimpulan : Toleransi dan efikasi penggunaan kateter intrapleura pada pasien kanker paru dengan efusi pleura masif cukup baik dan aman. Diperlukan penelitian kohort prospektif dengan jumlah sampel yang sama pada tiap kelompok kateter, sehingga penggunaan kateter dapat dianalisis perbandingannya dan penelitian dengan kelompok pembanding, contohnya tindakan pleurodesis, yang merupakan baku emas tatalaksana efusi pleura ganas.Background : Massive pleural effusion is one of the problems in lung cancer treatment that cause death. The main treatment of cancer patient with massive pleural effusion is the placement of intrapleural catheter. Catheters that can be used are water sealed drainage, indwelling pleural catheter or pigtail catheter. Currently, water sealed drainage is the most catheter used.Objective : This is a preliminary study which is aimed to assess tolerancies and efficacies of water sealed drainage, indwelling pleural catheter or pigtail catheter for treatment of lung cancer with massive pleural effusion.Methods : This study is a retroscpective observational cohort study. Subjects are lung cancer patients with massive pleural effusion and catheterized with intrapleural catheter (WSD, IPC or pigtail catheter). The datas were taken from medical record at RSUP Persahabatan between 1 January 2012-31 December 2015 and assessed for tolerancies (acute or late complication) and efficacies ((length of hospital admission after catheter placement, duration and the reason of retraction) of intrapleural catheterResults: Subjects of study are 77 patients, with characteristic, male (55,8%), median age 57 years old, range from 26 to 84 years old, adenocarcinoma (84,4%) and the most main therapy is chemotherapy (32,5%). Acute complication obtained in 70,1% patients, with the most common complication is pain in catheter location (58,4%). Late complication obtained in 54,5% patients with the most common complication is pain in the catheter location (29,9%). The mean of length of staying in hospital after the placement of catheter are 14,14 days, median 10 days, range from 1 to 72 days. The mean of duration of catheter placement is 55.98 days, median 30 days, range from 2 to 310 days. Minimal fluid production (46,75%) are the most reason of intrapleural catheter retraction.Conclusion: Tolerancies and efficacies of intrapleural catheter (WSD, IPC or pigtail catheter) in lung cancer patients with massive pleural effusion are quite good and safe. Prospective cohort studies are needed in the future to determine which type of intrapleural catheter is better for the treatment of massive pleural effusion in lung cancer patients and studies with comparison group for example pleurodesis, which is the gold standard for treatment of malignant pleural effusion."

"ABSTRAKPleural effusion is a condition when there is an accumulation of fluid in pleural space. The condition may manifest in breathing impariment by limiting lung expansion space. Pleural effusion is suffered by more than 1.5 million people per year in America. A study held ini Persahabatan Hospital between 2010-2011 found 119 cases of pleural effusion, 42,8% was malignant pleural effusion. Pleural malignancy is the most common indication for thoracocentesis, thus must be considered in massive pleural effusion (MPE). Theraphy for MPE is palliative with the goal being relief of dyspnea. Treatment option for MPA are deteminded by several factors: symptoms and performance status of the patient, the primary tumor type and its response to systematic therapy, and degree of lung re-expansion following pleural fluid removal. In this case, we will present a case of malignant pleural effusion as an illustration in searching of evidence in comparing between pleurodesis and indwelling pleural catheter in management of malignant pleural effusion. "

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Latar belakang :

Akses vaskular untuk hemodialisis adalah jalur kehidupan bagi pasien gagal ginjal. Pada pasien hemodialisis anak, kualitas hemodialisis yang baik mempengaruhi luaran pasien termasuk proses tumbuh kembangnya. Kualitas hemodialisis dipengaruhi oleh patensi dari akses vaskular.  Catheter double lumen (CDL) sebagai salah satu akses hemodialisis yang sering digunakan perlu dipertahankan patensinya agar dapat mendukung tercapainya blood flow yang ditargetkan. Kejadian trombosis kateter mempengaruhi patensi dari CDL. Alteplase (TPA) digunakansebagai trombolitik untuk trombosis kateter, di samping heparin, streptokinase, dan urokinase.

Subjek dan Metode:

Studi kohort dengan pembanding, subjek penelitian adalah anak berusia 0-18 tahun, mengalami penyakit ginjal kronik (PGK) stadium5, menjalani hemodialisis reguler di RSCM, terpasang CDL dan mengalami trombosis kateter. Analisis statistik dengan uji chi square dan uji t tidak berpasangan. Pengujian dilakukan dengan menggunakan piranti lunak SPSS version 20 for Windows.

Hasil :

Selama periode Januari 2014 sampai September 2019 terdapat 66 subjek yang memenuhi kriteria; pada kelompok terekspos terdapat 25 subjek (56,8%) laki-laki dan 19 subjek (43,2%) perempuan dengan dasar penyakit 28 subjek (63,6%) anatomis dan 16 subjek (36,4%) inflamasi. Pada kelompok tidak terekspos terdapat 6 subjek (50%) laki-laki dan 6 subjek (50%) perempuan dengan dasar penyakit 9 subjek (75%) anatomis dan 3 subjek (25%) inflamasi. Uji chi square menunjukkan keberhasilan trombolitik alteplase dengan nilai p signifikan (p=0,001).  Interpretasi kekuatan pengaruh berdasarkan Odd ratio mendapatkan bahwa pemberian alteplase dapat meningkatkan keberhasilan trombolitik 10.6 kali lebih besar dibandingkan tanpa alteplase. Penggunaan alteplase memberikan efisiensi biaya sebesar 37,10% terhadap kejadian trombosis kateter. Tidak ada kejadian efek samping yang dilaporkan pada penggunaan alteplase pada studi ini.

Kesimpulan:

Penggunaan alteplase 2mg/ml efektif dalam mengembalikan blood flow pada pasien hemodialisis anak yang mengalami trombosis kateter. Penggunaan alteplase memberikan efisiensi biaya dan minimal efek samping.

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Background  :

Vascular access for hemodialysis is a life line for end stage renal disease patient. In pediatric patients, the quality of hemodialysis affect the output include their growth and development. The quality of hemodialysis is influenced by the patency of access. Catheter double lumen (CDL) as one of the most commonly used hemodialysis access needs to be maintained in order to support the achievement of targeted blood flow. Catheter thrombosis affects CDL patency. Alteplase (TPA) is used as thrombolytic agent for catheter thrombosis, in addittion to heparin, streptokinase, and urokinase.

Methods :

 A cohort study with comparison, subject of study are children aged 0-18 years old, chronic kidney disease stage 5 who underwent regular hemodialysis at RSCM with double lumen catheter and had an thrombotic episode. Statistical analytic with chi square and unpaired t-test. Testing is done using software SPSS version 20 for Windows.

Result :

From January 2014 to September 2019 we found 66 subjects that fullfil the inclusion criteria, in the exposed group there are 25 subjects (56,8%) male and 19 subjects (43,2%) female with the basic disease 28 subjects (63,6%) anatomical and 16 subjects (36,4%) inflamation.  In the unexposed group there are 6 subjects (50%) male and 6 subjects (50%) female with the basic disease 9 subjects (75%) anatomical and 3 subjects (25%) inflamation. Chi square test show the success of alteplase as the thrombolitic with significance p value (p=0,001). Interpretation of influence strength based on odd ratio shows that alteplase could increased the successful of thrombolytic 10.6 higher than non-exposed group. The use of alteplase provides cost efficiency of 37,10%  for the incidence of thrombosis catheter. There is no side effect of alteplase that had been reported on this study.

Conclusion :

The use of alteplase 2mg/ml is effective in restoring blood flow in hemodialysis patients with catheter thrombosis.  The use of alteplase provides cost efficiency and minimal side effects.

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"Latar Belakang: Penyakit ginjal kronik pada anak memerlukan perhatian khusus, terutama dalam pemasangan catheter double lumen (CDL) untuk hemodialisis. Studi tentang faktor risiko disfungsi kateter pada anak dengan penyakit ginjal kronik yang menjalani hemodialisis bertujuan mengevaluasi hubungan antara parameter laboratorium, seperti kadar platelet dan albumin serum, dengan disfungsi kateter. Penelitian ini diharapkan dapat meningkatkan pemahaman mengenai faktor risiko disfungsi kateter pada anak dengan penyakit ginjal kronik.

Metode: Studi ini memiliki desain studi potong lintang yang dilakukan dengan menggunakan sampel data rekam medik dari pasien-pasien anak yang sudah menggunakan catheter double lumen (CDL) tunnel mulai bulan September hingga Oktober 2023.

Hasil: Sebanyak 59 pasien memenuhi kriteria pada penelitian ini yang sebagian besar memiliki jenis kelamin perempuan (50,8%) dan berusia >10 tahun (69,5%). Kadar platelet yang tinggi berhubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo (p=0,001). Kadar APTT tidak memiliki hubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo (p=0,810). Kadar albumin serum yang rendah atau hipoalbuminemia berhubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo (p=0,001). Faktor yang paling berpengaruh terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo adalah kadar albumin serum.

Kesimpulan: Kadar albumin dan platelet berhubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo. Faktor yang paling berpengaruh terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo adalah kadar albumin serum.

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Background: Chronic kidney disease in children requires special attention, particularly in the placement of double-lumen catheters (DLC) for hemodialysis. A study on the risk factors for catheter dysfunction in children with chronic kidney disease undergoing hemodialysis aimed to evaluate the relationship between laboratory parameters, such as platelet levels and serum albumin, and catheter dysfunction. This research is expected to enhance understanding of the risk factors for catheter dysfunction in children with chronic kidney disease.

Methods: This study employed a cross-sectional study design using medical record data samples from pediatric patients who had undergone double-lumen catheter (DLC) tunnel placement from September to October 2023.

Results: A total of 59 patients met the criteria for this study, the majority of whom were female (50.8%) and aged over 10 years (69.5%). High platelet levels were significantly associated with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo (p=0.001). APTT levels did not have a significant association with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo (p=0.810). Low serum albumin levels or hypoalbuminemia were significantly associated with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo (p=0.001). The most influential factor for catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo was serum albumin level.

Conclusion: Albumin levels and platelet are significantly associated with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo. The most influential factor for catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo was serum albumin level."