Pengambilan Darah pada

Pasien dengan Akses Vena

Sulit
Hubertus Hosti Hayuanta
 ±218 tes Pengambilan
darah vena

2,351,643
±74 % 2% gagal
darah vena
23,790
0.4% 3-11 pengambilan
16.6% ekimosis
35.3% nyeri berlebih

• Howanitz PJ, Schifman RB. Inpatient phlebotomy practices. A College of American Pathologists Q-Probes quality improvement study of 2,351,643 phlebotomy requests.
1994 Jun;118(6):601-5.
• Howanitz PJ, Cembrowski GS, Bachner P. Laboratory phlebotomy. College of American Pathologists Q-Probe study of patient satisfaction and complications in 23,783
patients. Arch Pathol Lab Med. 1991 Sep;115(9):867-72.
 Kondisi akses
vena sulit

Pasien anak Pasien kanker

Pasien geriatri Pasien fobia jarum

Pasien obesitas
Pasien gangguan
IVDU kognitif/cenderung
melawan
CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
 Pasien anak
Masalah

Sensitivitas nyeri >

orang dewasa
Efek jangka panjang

Toleransi Kapasitas Persepsi

nyeri ↓ coping ↓ nyeri ↑

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
• Saxena I, Kumar M, Barath AS, Verma A, Garg S, Kumar M. Effect of Age on Response to Experimental Pain in Normal Indian Males. J Clin Diagn Res. 2015 Sep; 9(9):
CC05–CC08.
 Pasien anak
Manajemen
Komunikasi verbal
• Gambarkan sensasi
• Sesuai realitas

Partisipasi pasien

Pengalihan perhatian

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
 Pasien anak
Manajemen (2)
Keterlibatan orang tua
Kegelisahan orangtua mempengaruhi anak

Posisi nyaman

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
• World Health Organization. (2010). WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organization.
https://apps.who.int/iris/handle/10665/44294
 Pasien anak
Manajemen (3)

Obat dan alat

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
• Susam V, Friedel M, Basile P, Ferri P, Bonetti L. Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial. Acta Biomed.
2018; 89(Suppl 6): 6–16.
Susam V, Friedel M, Basile P, Ferri P, Bonetti L. Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial. Acta Biomed.
2018; 89(Suppl 6): 6–16.
 Pasien anak
Manajemen (4)
Pungsi tumit dan jari

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
• World Health Organization. (2010). WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organization.
https://apps.who.int/iris/handle/10665/44294
 Pasien geriatri
Masalah Manajemen

Vena sulit ditemukan Menghangatkan lokasi

dehidrasi, TD rendah, keterbatasan gerak, pungsi
massa otot <<

Vena mudah bergulir Fiksasi vena

Vena mudah kolaps Tabung vakum kecil

dan/atau rapuh Jarum kecil
Spuit & tarikan perlahan

Vena tidak elastis Situs lain

CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
 Pasien obesitas
Masalah Manajemen
Vena sulit ditemukan Menghangatkan lokasi pungsi
Menggunakan NIR vein finder
tertutup lapisan lemak Menggunakan manset bariatrik

Vena mudah bergulir

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
• Pan CT, Francisco MD, Yen CK, Wang SY, Shiue YL. Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR)
Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy. Sensors (Basel). 2019 Aug; 19(16): 3573.
Pan CT, Francisco MD, Yen CK, Wang SY, Shiue YL. Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near
Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy. Sensors (Basel). 2019 Aug; 19(16): 3573.
 Pasien obesitas
Masalah Manajemen
Vena sulit ditemukan Menghangatkan lokasi pungsi
Menggunakan NIR vein finder
tertutup lapisan lemak Menggunakan manset bariatrik

Vena mudah bergulir Fiksasi vena

• CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
• Pan CT, Francisco MD, Yen CK, Wang SY, Shiue YL. Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR)
Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy. Sensors (Basel). 2019 Aug; 19(16): 3573.
 Intravenous drug users
Masalah Manajemen

Jaringan parut pada kulit • Hindari pungsi di lokasi

dan vena yang tidak boleh
• Rekomendasi pasien
mungkin tidak sesuai
• Lokasi distal jaringan
parut

Vena mudah bergulir Fiksasi vena

CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
 Pasien kanker
Masalah Manajemen
Vena sulit ditemukan Menghangatkan lokasi
pungsi

Vena mudah bergulir Fiksasi vena

Vena mudah kolaps Tabung vakum kecil

dan/atau rapuh Jarum kecil
Spuit & tarikan perlahan

Vena tidak elastis Situs lain

Mastektomi Situs lain

CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
 Pasien fobia jarum
Masalah Manajemen

Sensitivitas nyeri >> Meyakinkan

Tidak berlama-lama

Posisi nyaman

Pengalihan perhatian

CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
 Pasien gangguan kognitif/cenderung
melawan
Masalah Manajemen

Membahayakan diri Asistensi

sendiri, flebotomis, dan
orang di sekitar
Peralatan flebotomi jauh
dari pasien

Jalan keluar tidak terhalang

CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI standard GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
William Harvey
(1578-1657)
William Harvey
(1578-1657)
Penutup
• Persiapkan diri, alat

• Yakin/berpura-pura yakin

• Perseptif

• Minta bantuan
Terima Kasih