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Abstrak :
Penelitian ini bertujuan untuk mengetahui "Efektivitas kateterisasi urin menggunakan jelly anestesi dan jelly biasa terhadap respon nyeri pasien laki – laki di RSUD Muntilan dan PKU Muhammadiyah DIY". Desain penelitian Quasi eksperimen; post-test only control group. Pengambilan sampel dilakukan secara nonprobability sampling dengan metode purposive sampling, Sampel penelitian berjumlah 30 responden yang terbagi dalam dua kelompok. Hasil uji statistik Mann–Whitney didapatkan angka significancy 0,000. Kesimpulan penelitian bahwa terdapat perbedaan yang signifikan pada skala nyeri keterisasi urin menggunakan jelly anestesi dan jelly biasa pada pasien laki - laki. Dari hasil penelitian, jelly anestesi direkomendasikan diberikan 3 menit sebelum pemasangan kateter urin laki - laki.

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This research aimed to show the effectiveness of urine catheterization using anesthetics jelly and water based lubricant for male patients’ pain response at RSUD Muntilan and PKU Muhammadiyah DIY. The research design used quasi experiment; post test only control group. Sample was taken by nonprobability sampling with purposive sampling method.In this study, there were 30 respondents which were divided into two groups. The Mann-Whitney test indicated a significant difference in urine catheterization pain score response using anesthetics jelly and common jelly for male patients. From this study, anesthetics jelly was recommended to use with 3 min delay following instillation of anesthetics jelly before urine catheterization for male patients.

Abstrak :
Kateterisasi jantung adalah tindakan diagnostik dan intervensi terhadap penyakit jantung koroner. Nyeri punggung merupakan keluhan yang banyak diungkapkan oleh pasien yang menjalani kateterisasi jantung. Tujuan penelitian ini untuk mengetahui pengaruh mobilisasi dini terhadap nyeri punggung pada pasien post kateterisasi jantung. Desain penelitian adalah randomized controlled trials dengan single blind. Sebanyak 46 responden dibagi menjadi kelompok kontrol dan kelompok intervensi dengan metode randomisasi blok. Hasil penelitian menyimpulkan rerata nyeri punggung pada kelompok kontrol sesudah diberikan perlakuan lebih tinggi secara bermakna daripada kelompok intervensi (p value =0,01) dan selisih peningkatan nyeri punggung pada kelompok kontrol lebih tinggi daripada kelompok intervensi (p value =0,042). Kesimpulan dari penelitian ini adalah peningkatan nyeri punggung pada pasien yang diberikan mobilisasi dini lebih rendah dibandingkan peningkatan nyeri punggung pada pasien yang tidak diberikan mobilisasi dini. Rekomendasi untuk penelitian selanjutnya dapat ditambahkan intervensi massage punggung untuk menurunkan ketegangan otot punggung. ......Cardiac catheterization is increasingly used in hospitals in Indonesia as diagnostic and interventional interventions against coronary heart disease. Back pain is a major complaint expressed by many patients who undergoing cardiac catheterization as prolonged bed rest period without any change in the position for more than 6 hours till tomorrow morning is commonly use. The purpose of this study were to determine the effect of early mobilization toward backpain in patients post cardiac catheterization. The study design was a randomized controlled trials with singleblinded. The sample size was 46 respondents which divided to two groups: control group and intervention group by using block randomization method. The result of this study showed that mean backpain's scale in control group was significantly higher than the intervention group (pvalue = 0.01) after the interventios were given, and the difference in mean backpain’s scale in the control group is higher than the intervention group (p value = 0.042). This study conclude that backpain’s scale elevated in patients whose given early mobilization is lower than the in backpain's scale in patients whose are not given early mobilization. Recommendations for further research is added another interventions to reduce tension of back muscles such as back massage.

Abstrak :
Prosedur kateterisasi jantung berkaitan erat dengan penggunaan teknik fluoroskopi dalam waktu relatif lama. Dalam penelitian ini dilakukan analisa dosis radiasi personel kateterisasi jantung berdasarkan koleksi data hasil pantauan berkala Balai Pengamanan Fasilitas Kesehatan Jakarta dari berbagai rumah sakit. Untuk verifikasi, dilakukan pengukuran dosis personel kateterisasi jantung selama berlangsung prosedur Coronary Angiography dan Percutaneous Coronary Intervention. Setiap personil menggunakan 4 dosimeter, 2 film badge dan 2 TLD badge, dimana 1 film badge dan 1 TLD badge diletakkan di bawah apron sedangkan yang lain berada di luar apron dekat leher. Dari koleksi data diperoleh informasi dosis personel pengguna film badge per tahun pada umumnya berada dalam rentang (0,10–10) mSv untuk dokter, (0,10–7,20) mSv untuk perawat, dan (0,10–1,30) mSv untuk radiografer. Adapun dosis personel pengguna TLD badge per tahun tercatat (0,01–14) mSv untuk dokter, (0,01–14,50) mSv untuk perawat dan (0,01–2,50) mSv untuk radiografer. Dari hasil pengukuran di 3 rumah sakit diperoleh estimasi dosis efektif per tahun tertinggi dokter dalam rentang (4,96–8,71) mSv, perawat dalam rentang (7,51–37,34) mSv dan radiografer dalam rentang (7,40–25,32) mSv. Hasil pengukuran menunjukkan para personel kateterisasi jantung berpotensi menerima dosis tinggi, dapat melebihi nilai batas dosis sebesar 20 mSv/tahun. ...... Cardiac catheterization procedures were closely related to the use of fluoroscopy techniques in a relatively long time. In this study, radiation dose analysis for cardiac catheterization personnel was carried out based on data collected from the results of periodic monitoring of the Jakarta Health Facility Security Center from various hospitals. For verification, dose measurements of cardiac catheterization personnel were performed during the Coronary Angiography and Percutaneous Coronary Intervention procedures. Each personnel used 4 dosimeters, 2 film badges, and 2 TLD badges, where 1 film badge and 1 TLD badge were placed under the apron while the others were outside the apron near the neck. From the data collection, information on the dose of personnel using the film badge per year was generally in the range (0.10–10) mSv for doctors, (0.10–7.20) mSv for nurses, and (0.10–1.30 ) mSv for radiographers. The dose of personnel using the TLD badge per year was recorded (0.01–14) mSv for doctors, (0.01–14.50) mSv for nurses, and (0.01–2.50) mSv for radiographers. From the results of measurements in 3 hospitals, the highest estimated effective dose per year was doctors in the range (4.96–8.71) mSv, nurses in the range (7.51–37.34) mSv, and radiographers in the range (7.40– 25.32) mSv. The measurement results show that cardiac catheterization personnel had the potential to receive high doses, which can exceed the dose limit value of 20 mSv/year.

Abstrak :
Angiografi koroner dan PCI/PTCA transfemoral, dapat menimbulkan komplikasi perdarahan dan haematom. Penggunaan bantal pasir 2,3 kg sebagai penekan mekanikal dapat meminimalkan insiden perdarahan dan haematom, akan tetapi penggunaan bantal pasir 2,3 kg terlalu lama dapat menimbulkan rasa tidak nyaman bagi klien. Penelitian ini bertujuan untuk mengetahui perbandingan efektifitas penekanan mekanikal dengan bantal pasir 2,3 kg antara 2, 4 dan 6 jam terhadap insiden perdarahan, haematom dan rasa tidak nyaman. Metode penelitian randomized controlled trial desain paralel tanpa matching. Metode sampling randomisasi dengan random blok. Jumlah sampel 90 orang, kelompok intervensi I 30 orang, intervensi II 30 orang dan kontrol 30 orang. Kelompok intervensi I menggunakan bantal pasir 2,3 kg selama 2 jam, kelompok intervensi II selama 4 jam dan kelompok kontrol selama 6 jam. Observasi dan pengukuran dilakukan setiap 2 jam pada semua kelompok, alat ukur yang digunakan lembar observasi, tensi digital terkalibrasi, monofilamen dan keluhan rasa tidak nyaman. Hasil penelitian tidak ada responden yang mengalami perdarahan pada semua kelompok, tidak ada perbedaan insiden haematom diantara kelompok (p value = 0,866). Ada perbedaan signifikan tingkat rasa nyaman diantara kelompok pada observasi 4 jam (p value = 0,003) dan pada observasi 6 jam (p value = 0,0005). Perlu modifikasi SOP tentang penggunaan bantal pasir 2,3 kg sebagai penekan mekanikal dari 6 jam menjadi 2 jam. Penggunaan bantal pasir 2,3 kg 2 jam tidak meningkatkan insiden perdarahan dan haematom, akan tetapi meningkatkan rasa nyaman klien. ...... Angiography coroner and PTCA with transfemoral approach of catheter commonly having vascular complications, such as bleeding and hematoma. Using a 2,3 kg sandbag as a mechanical compression to minimize incidence of bleeding and hematoma in a longer period of compression would have side effect that increase patient discomfort. This study was aim at evaluating the different effects of putting a sandbag 2,3 kg between two, four, and six hours on femoral access site after cardiac invasive procedure toward vascular complications rate and the severity of discomfort level. The research design was randomized control trial study where 90 patients were included and divided randomly into three different groups. A 2,3 kg sandbag was applied for two hours, four hours, and six hours after sheath removal, to the first, second, and third group respectively. Every 2 hours until 6 hours the observation of bleeding, hematoma and discomfort for each groups were taken with sphygmomanometer digital, monofilament and the observation sheets. The result of study demonstrated that no patient has any bleeding as a complication of procedure, and there is no significant differences incidence of hematoma between groups (p value = 0,866), however there is significant differences the client experienced of discomfort were found after 4 hours using 2,3 kg sandbag on femoral access site as a mechanical pressure (p value = 0,003), and after 6 hours (p value = 0,0005). As a research recommendation a of SOP is required from six hours becomes two hours in using a 2,3 kg sandbag as a mechanical pressure.

Abstrak :
Latar Belakang: Pemasangan akses intravena pada pasien pediatrik memiliki kesulitan tersendiri, selain ukurannya yang lebih kecil, pembuluh darah lebih rapuh, dan jaringan subkutan pada pediatrik lebih tebal sehingga visualisasi vena tidak jelas.Pada pasien pediatrik yang tidak dalam pengaruh anestesia, pasien sering kali tidak kooperatif karena takut dan trauma akibat tindakan sebelumnya, yang berdampak pada angka keberhasilan upaya pertama insersi kanul intravena pada pediatrik rendah. Alat pemindai vena dengan prinsip kerja sinar infra-merah dapat membantu visualisasi vena namun efektifitasnya dalam keberhasilan insersi pada pasien pediatrik masih kontradiktif. Penelitian ini bertujuan untuk membandingkan angka keberhasilan insersi kanul intravena pada upaya pertama menggunakan pemindai vena dan tanpa pemindai vena pada pasien pediatrik, sehingga dapat menjadi suatu dasar usulan standart operasional di RSCM. Metode: Penelitian ini uji klinis acak tidak tersamar pada pasien pediatrik usia 0-5 tahun yang mendapat layanan anestesia di ruang diagnostik MRI, CT dan Radioterapi RSCM. Subjek penelitian berjumlah 92 pasien yang dikelompokkan menjadi 2 grup sesuai tabel randomisasi. Pada grup pemindai vena dilakukan insersi kanul intravena dengan bantuan alat pemindai vena (Accuvein AV400) dan pada grup kontrol dilakukan insersi tanpa alat bantu tambahan. Diambil data keberhasilan insersi pada upaya pertama, waktu pemasangan dan total jumlah upaya, selain itu dicatat status demografi jenis kelamin, usia, tinggi badan, berat badan, lingkar lengan atas dan indeks massa tubuh. Analisis data dilakukan untuk melihat data demografi, faktor yang mempengaruhi dan hubungan penggunaan pemindai vena dengan keberhasilan upaya pertama insersi. Hasil: Angka keberhasilan upaya pertama pada kelompok peminda vena adalah 76,1% dibandingkan tanpa pemindai vena 52,2% dengan cOR 2,92 (p 0,017). Faktor warna kulit memiliki angka keberhasilan yang lebih tinggi pada warna kulit gelap sebesar 74,5% dibandingkan warna kulit terang 53,5% (p 0,035). Faktor lain seperti usia, jenis kelamin, dan status gizi pada penelitian ini secara statistik tidak berhubungan dengan keberhasilan insersi kanil intravena. Selain itu didapatkan data deskriptif pada kelompok pemindai vena memiliki median lama waktu yang lebih singkat yaitu 133,5 (55-607) dibandingkan tanpa pemindai vena 304,5 (65-1200). Simpulan: Kelompok pemindai vena memiliki angka keberhasilan upaya pertama insersi yang lebih tinggi dibandingkan tanpa pemindai vena. pada penelitian ini faktor yang mempengaruhi keberhasilan insersi hanya warna kulit. Kata Kunci: akses intravena, pediatrik, pemindai vena

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Background: Establishing intravenous access in pediatric patients has its own challanges, in addition to their smaller size, blood vessels are more fragile, and subcutaneous tissue is thicker so that visualization of veins is often unclear. In pediatric patients who are awake, patients are often not cooperative because of fear and trauma due to previous experiencethus the success rate of the first attempt venous cannulation in pediatric patient is low. The vein viewer with the principle of infrared rays can help visualize the vein but its effectiveness in the success of insertion in pediatric patients is still contradictory. This study aims to compare the success rate of the first attempt venous cannulation between using vein veiwer and control in pediatric patients. Metho: This study is an openrandomized clinical trials in pediatric patients aged 0-5 years who received anesthesia procedure in the diagnostic room for MRI, CT and Radiotherapy at Cipto Mangunkusumo Hospital. The research subjects were 92 patients grouped into 2 groups according to the randomization table. In the vein viewer group, Venous cannulation was performed with the help of a vein viewer (Accuvein AV400) and in the control group cannulation was done without additional assistive devices. Data on first attempt success rate, time of cannulation and total number of attempts in recorded. In addition, demographic status such as sex, age, height, weight, upper arm circumference and body mass index is also recorded. Data analysis was performed to search for the relationship of the use of vein viewer with the success of the first attempt at cannulation. Result: The success rate of the first attempt at the vein viewer group was 76.1% compared with control group 52.2% with cOR 2.92 (p 0.017). Skin color factor has a higher first attempt success rate in dark skin color of 74.5% compared to light skin color 53.5% (p 0.035). Other factors such as age, sex, and nutritional status in this study were not statistically related to the success of first attempt venous cannulation. In addition, secondary data were obtained that vein viewer group has shorter median cannulation time of 133.5 (55-607) than control 304.5 (65-1200). Conclusion: The vein viewer group has a higher success rate of first attempts venous cannulation than control group. In this study the factors that influence the success rate of first attempts venous cannulation are only skin color. Keywords: Peripheral accesss, ediatric, Veinviewer

Abstrak :
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. ......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.

Abstrak :
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 :
Pendahuluan: Akses vaskular merupakan komponen penting pada terapi hemodialisis. Akses vaskular sementara menggunakan kateter sebelum akses permanen berupa fistula arteriovena. Kateter hemodialisis sebaiknya menggunakan tunneled double lumen catheter (TDLC). KDOQI 2006 menyarankan posisi ujung kateter berada di mid-atrium kanan. Pemasangan TDLC pada pasien-pasien dewasa di Rumah Sakit Cipto Mangunkusumo (RSCM) belum sepenuhnya menggunakan panduan fluoroskopi dalam mengetahui lokasi ujung kateter. Diperlukan penelitian untuk membandingkan ketepatan lokasi ujung kateter pada pemasangan TDLC dengan panduan fluoroskopi dibandingkan dengan tanpa panduan fluoroskopi. Metode: Penelitian ini merupakan studi potong lintang, dilakukan di RSCM dan RS. Hermina Bekasi pada bulan Maret-April 2017. Subjek penelitian adalah pasien penderita penyakit ginjal tahap akhir dewasa yang menjalani hemodialisis dengan menggunakan TDLC yang ditindak di RSCM dan RS Hermina Bekasi. Pengambilan sampel dilakukan secara consecutive. Luaran penelitian ini adalah ketepatan lokasi ujung kateter pada pemasangan TDLC dengan panduan fluoroskopi dibandingkan dengan pemasangan tanpa panduan fluoroskopi. Luaran lain yang dinilai adalah adekuasi berupa tarikan aliran darah pada saat hemodialisis (blood flow/Qb). Hasil: Studi ini meliputi 97 sampel dari masing-masing kelompok pemasangan TDLC. Terdapat perbedaan bermakna pada ketepatan posisi ujung kateter di dalam mid-atrium antara pemasangan TDLC dengan panduan fluoroskopi dibandingkan dengan tanpa panduan fluoroskopi, RR 5,603 (CI 95% 3,11-10,08; p < 0,001). Studi mengenai Qb meliputi 115 sampel dari kelompok fluoroskopik dan 55 sampel dari kelompok non fluoroskopik. Pada kelompok fluoroskopi, terdapat 3 subjek blood flow nya 300mL/menit ke atas, sedangkan pada kelompok non fluoroskopi terdapat 37 subjek yang blood flow nya 300mL/menit ke atas. Kesimpulan: Penggunaan panduan fluoroskopi pada pemasangan TDLC meningkatkan ketepatan posisi ujung kateter dibandingkan dengan tanpa panduan fluoroskopi. Terdapat limitasi penelitian pada luaran Qb, dikarenakan tidak memenuhi besar jumlah sampel minimal, sehingga penelitian ini tidak dapat melakukan analisis hubungan ketepatan lokasi ujung kateter dengan adekuasi. ......Introduction: Vascular access is an important part of hemodyalisis therapy. Temporary vascular access uses catheter before permanent access is set such as arteriovenous fistula. Hemodyalisis catheters sould use tunneled double lumen catheter (TDLC). KDOQI 2006 suggested that the position of the tip of the catheter ends in right mid-atrium. TDLC installment in adult patients in Rumah Sakit Cipto Mangunkusumo hospital (RSCM) does not fully use fluoroscopy guidance to ensure the locaation of the catheter tip. Research is needed to compare the position of catheter tip of TDLC installation between the usage of fluoroscopy guide and not. Method: This was a cross sectional study conducted in RSCM and Hermina Bekasi Hospital from March to April 2017. The subjects of this research were patients with end stage kidney disease that underwent hemodyalisis with TDLC that were installed in RSCM and Hermina Bekasi Hospital. The subjects were taken consecutively. The outcome of this study was comparison between the accuracy of catheter tip position in TDLC installation with fluoroscopy guided and non guided. The other outcome was adequation in the form of blood flow in hemodyalisis (blood flow/Qb) Results: This study included 97 samples from each group of TDLC installation. There is a significant difference between fluoroscopy guided and non guided in TDLC installation catheter tip position wether it is in the mid-atrium or not with RR 5,603 (CI 95% 3,11-10,08; p < 0,001). The study about Qb included 115 samples from fluoroscopic group and 55 samples from non fluoroscopic group. There are 3 subjects whose blood flow were >300mL/minute, while in the non fluoroscopic group there were 37 subjects whose blood flow were > 300mL/minute. Conclusion: The usage of fluoroscopy guide in TDLC installment rises the accuracy of catheter tip position compared to non fluoroscopy guided TDLC installment. There was limitation in Qb outcome because the sample size was not enough, therefore the study about catheter tip position and adequation could not be analyzed.