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Peripheral

Intraosseous
Intravenous
Catheter
Catheter (PIVC)

Venous Central Venous


Cutdown Catheter (CVC)
Peripheral intravenous catheter
(PIVC)
Persiapan

Persiapan alat
Identifikasi identitas
Informed consent
Mengidentifikasi vena yang akan menjadi
lokasi pemasangan
Cuci tangan dan pakai sarung tangan

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual


Prosedur Tindakan

Pasang torniket 8 sampai 15 cm diatas lokasi


pemasangan
Lakukan desinfeksi
Jarum diinsersikan ke dalam vena dengan bevel jarum
menghadap ke atas, membentuk sudut 30-40o
terhadap permukaan kulit.
Bila jarum berhasil masuk ke dalam lumen vena, akan
terlihat darah mengalir keluar.

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual


Prosedur Tindakan

Turunkan kateter sejajar kulit. Tarik jarum tajam


dalam kateter vena (stylet) kira-kira 1 cm ke arah luar
untuk membebaskan ujung kateter vena dari jarum
agar jarum tidak melukai dinding vena bagian dalam.
Dorong kateter vena sejauh 0.5 1 cm untuk
menstabilkannya.
Tarik stylet keluar sampai panjang stylet. Lepaskan
ujung jari yang memfiksasi bagian proksimal vena.
Dorong seluruh bagian kateter vena yang berwarna
putih ke dalam vena.

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual


Prosedur Tindakan
Torniket dilepaskan. Angkat keseluruhan stylet dari
dalam kateter vena.
Pasang infus set atau blood set yang telah terhubung
ujungnya dengan kantung infus atau kantung darah.
Tutup dengan kasa steril dan fiksasi dengan plester.
Cuci tangan dan Dokumentasi

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual


PIVC SELECTION

*Insertion and Management of Peripheral Intravenous Cannulae in Western Australia Healthcare Facilities Policy
INDIKASI USGPIV
Visualizing Vein
Differentiate between arteries and veins
Vein are compressible, thinner wall
Arteries are not compressible, pulsate, thicker wall
Short Axis and Long Axis
Intraosseous Catheter
Indication

Dificulty in establishing venous access, as in the


following setting : burns, obesity, edema, seizure.

Contraindication

Abolute: Bone trauma at or porximal to the


insertion site, or previous insertion in same limb.
Infection overlyin the point of insertion.
Relative: Difficulty in identifying anatomical
landmark
Common Access Site
Humeral Head
With the elbow bent, and the patients hand on their
abdomen, palpate the surgical neck of the humerus to
locate the greater tuberosity. The insertion site
approximately 1 cm above the surgical neck and 2-3 cm
lateral to the bicep tendon. Insert at 45degree angle,
aiming toward the opposite scapula.
Common Access Site
Proximal Tibia
2 cm medial and 1-2 cm below patella, palpate the tibial tuberosity and ensure that
you can feel bone below subcutaneous tissue. The needle should be angled slightly
distally, away from knee

Distal Tibia

Distal Femur

Sternum
Procedure
Sterilisation of the skin at the needle insertion site
Manual stabilisation of the bone during insertion
Aspiration after needle insertion confirms successful
placement
In the awake patient, injection of local anaesthetic
(preferably lidocaine) into the IO needle prior to use can
reduce pain for subsequent infusion
Ensure the needle flush with at least 10ml of fluid after
drug administration
Frequent assessment of the IO site for sign of extravasation
Venous Cutdown
Technique

Infiltrate the skin with local anaesthetic


Make a 1,5-2 cm transverse incision over the vein
Bluntly dissect out the vein by opening the forceps in the
line of the vein
Make a small stab skin incision 1cm distal to the incision in
the line of the vein. Pass two ligature around the vein. Tie
the distal one, but leave the end uncut. Hold the end of
the ligature with the artery forceps
Whilst holding the ligature tight, make a V shaped
incision in the anterior surface of the vein with scissors or
scalpel
Pass the cannula through the inferior stab incision and
through the V shape incision into the vein. Tie the
proximal ligature tighly over the cannulated vein and, if
there is no bleeding,now cut the end of ligatures. If
bleeding occurs place a further ligature around the vein.
Connect the cannula to the giving set and commence
infusion.
Close the skin with sutures
Central Venous Catheter
Indication
Vascular access
Volume loading
Provision of caustic medication or solution
Central venous pressure monitor
Repeated blood sampling
Contraindication
Distorted anatomy
Infection at the site access
Bleeding disorder or anticoagulation
Combative patient
Sites

Internal jugular Vein Subclavian Vein

Femoral Vein
Technique

Setup of equipment and sterile preparation


Landmarking the access site
Anaesthesia
Placing the introducer needle into the vein
Assessment for venous placement
Insertion of guide wire
Remove the introducer needle
Skin incision
Insertion of dilator
Placement of catheter
Remove the guide wire
Flushing and capping the line
Secure the catheter