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Abstrak :
Latar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.Kata kunci: stenosis vena sentral, kateter hemodialisis temporer, akses vaskular ......Background The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter

Abstrak :
Latar belakang: Kanulasi vena femoralis menjadi pilihan ideal pada kondisi gawat darurat untuk resusitasi, pemberian cairan secara cepat dan masif serta obat-obatan pekat ataupun saat akses perifer sulit. Kanulasi dilakukan menggunakan ultrasonografi atau topografi anatomi. Penggunaan USG kurang praktis karena bergantung ketersediaan alat dan pengalaman operator. Teknik topografi anatomi bergantung pada terabanya pulsasi arteri femoralis. Penelitian ini bertujuan membandingkan keberhasilan kanulasi vena femoralis antara teknik V sebagai topografi anatomi baru yang tidak bergantung pada pulsasi arteri, dibandingkan dengan perabaan pulsasi arteri, sehingga dapat menjadi alternatif teknik kanulasi vena femoralis. Metode: Penelitian ini merupakan uji klinis acak tidak tersamar. Subjek penelitian sebanyak 100 pasien yang membutuhkan kanulasi vena femoralis sesuai kriteria eligibilitas. Dilakukan randomisasi menjadi dua kelompok. Kelompok pertama dilakukan kanulasi vena femoralis dengan teknik V, kelompok kedua dengan teknik perabaan pulsasi arteri. Data yang dinilai berupa keberhasilan kanulasi, keberhasilan percobaan pertama, jumlah percobaan dan komplikasi. Hasil: Dari 50 subjek pada tiap kelompok, keberhasilan kanulasi vena femoralis dengan teknik V sebanyak 92%, dengan teknik perabaan pulsasi sebanyak 88% (p=0,739). Keberhasilan pada percobaan pertama dengan teknik V sebanyak 84,8%, dengan teknik perabaan pulsasi sebanyak 70,5% (p=0,167). Komplikasi pungsi arteri terjadi pada kelompok teknik V sebanyak 8%, tidak terdapat kejadian hematoma pada kelompok ini. Pada kelompok perabaan pulsasi arteri 12% subjek mengalami pungsi arteri dan 8% subjek terjadi hematoma saat kanulasi. Simpulan: Keberhasilan kanulasi vena femoralis dengan teknik V tidak lebih tinggi dibandingkan dengan teknik perabaan pulsasi arteri femoralis. ......Background: Femoral vein cannulation is an ideal choice in emergency situations for resuscitation, rapid-massive rehidration, or difficult intravenous access. Cannulation is performed using ultrasound-guided or anatomical landmark. Ultrasound-guide technique is less practice because it depends on the availability of tools and operator experience. Anatomical landmark technique depends on femoral artery pulsation. This study aims to compare success rate of femoral vein cannulation between V technique as a new landmark that does not depend on arterial pulsations compared to arterial palpation technique, we hoped it can become an alternative technique. Methods: This study was randomized clinical trial. The subjects were 100 patients who required femoral vein cannulation according to the eligibility criteria. Patients were randomized into two groups. The first group, femoral vein cannulation was using V technique, and the second was using arterial palpation. Outcome measures include success rate, first attempt success rate, number of attempts and complications. Results: 50 subjects in each group, the success rate using V technique was 92%, by arterial palpation technique was 88% (p=0.739). First attempt success rate using V technique was 84.8%, by arterial palpation technique was 70.5%, (p=0.167). The complications rate, arterial puncture in the V technique group was 8%, no hematoma incidents in this group. Meanwhile, in arterial palpation technique group was 12% experienced arterial puncture, and 8% experienced hematoma. Conclusion: The success rate of femoral vein cannulation using V technique is not higher than using arterial palpation technique.