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Abstrak :
Introduction: Steal syndrome that occurs due to vascular access is one of the most feared complications after making a fistula arteriovenous (FAV). It is necessary to develop an assessment for early detection. Hand ischemia questionnaire (HIQ) and measurement of peak systolic velocity (PSV) of the radial artery and the ulnar artery are a form of subjective and objective examinations used to detect steal syndrome. The aim is to determine the correlation between HIQ and PSV of the radial artery and ulnar artery in hemodialysis patients with upper arm’s native FAV to detect symptoms of steal syndrome. Method: This is a cross-sectional study conducted in Cipto Mangunkusumo National Hospital from March to May 2019. Patients undergoing hemodialysis using upper arm native access FAV with or without symptoms of ischemia in the hands were included. Patients were asked to fill HIQ by interview, and then continued with measurement of PSV of the radial arteries and distal ulnar arteries from the hands with FAV. Results: A total of 80 samples were taken with 43 were women (53.8%), and 37 were men (46.2%). About 91.2% of the samples were FAV at the brachiocephalic level. The median age of the samples was 53 years. From the total HIQ score obtained, the results were a minimum of 0, maximum of 70, and a median value of 3. PSV of radial artery were minimum of 20 cm/s, maximum of 79 cm/s, and median 40 cm/s. The minimum PSV of the ulnar artery was 16 cm/s, the maximum was 70 cm/s, and the median was 41 cm/s. There was a significant correlation between the hand ischemia questionnaire and the peak systolic velocity of the radial artery and the ulnar artery in patients with native upper arm FAV (p <0.001), but after diagnostic testing, it was found that sensitivity was only 15% and specificity was 100%. Conclusion: There was a significant correlation between hand ischemia questionnaire and peak systolic velocity of the radial artery and ulnar artery in patients with upper arm native FAV, but due to the low sensitivity, the hand ischemia questionnaire cannot be used as an initial examination to detect steal syndrome in patients with no symptoms of hand ischemia.

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 midatrium. 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.