PENCEGAHAN DAN

PENGENDALIAN PLEBITIS

Disampaikan
Pada pelatihan IPCN
Himpunan Perawat Pengendali Infeksi
Jakarta, 18 23 Juli 2011

POKOK BAHASAN
Pendahuluan
Pengertian
Faktor faktor yang
mempengaruhi
plebitis
Pencegahan dan pengendalian
plebitis

PENDAHULUAN
Pemasangan infus melalui vena perifer dapat
berisiko terjadinya plebitis
Insiden plebitis di RS JPDHK 7.5 % ( 2009 )
The incidence of infusion phlebitis is estimated
to be as high as 62% of patients with an
intravenous access device in place (Lundgren,
Jordfeldt & Ek 1993).

PENGERTIAN
Peradangan pada vena perifer

plebitis sering dihubungkan dengan

pembentukan bekuan darah (trombosis)
Tromboflebitis

Secara klinis adanya keluhan nyeri, nyeri tekan,

bengkak,
pengerasan, eritema dan hangat pada vena oleh

FAKTOR FAKTOR YANG MEMPENGARUHI

PLEBITIS

Usia
Jenis kelamin
Kondisi dasar ( yakni. diabetes
melitus,
infeksi, luka bakar )
Faktor kimia seperti obat atau cairan
yang
iritan
Faktor mekanis seperti bahan, ukuran
kateter,
lokasi dan lama kanulasi

Catheter Related Infection

Risk
Catheter site
SKIN ORGANISMS
Endogenous Flora
Extrinsic
HCW
Contam Disinfectant
Invading Wound

CONTAMINATION OF
CATHETER HUB
Extrinsic (HCW)
Endogenous (Skin)

CONTAMINATED
INFUSATE
Fluid
Medication
Contaminated
Extrinsic
Infusate

CONTAMINATION OF DEVICE
PRIOR TO INSERTION
Extrinsic

Skin
Vein

Fibrin
Fibrinsheath,
Sheath
Thrombus
Thrombus

HEMATOGENOUS
HEMATOGENOUS,
From
Distant
Local
Infection
From
distant
local
Infection

Jenis Jenis Plebitis

1.Plebitis Kimia
2. Plebitis Mekanis
3. Plebitis Bakterial

Patofisiologi
Faktor etiologi plebitis
(spontan, komplikasi ,
psangan infus)
Pengaruh
penurun
Menyebabkan
histamine,
Kerusakan
bradikinin, dan
dan iritasi PB
serotonin

Nyeri

Tidak diatasi
Terbentuknya
faktor
procoagulan
di endothelial

Permeabilitas
kapiler me

Mengaktifasi
proacugulan

Penumpukan cairan & protein

di intertitial space

Collect
leukosit

Edema
dan
tendernes

Hipertermi
a

Inflammato
ry
continued

1.Plebitis Kimia
pH dan osmolaritas cairan infus yang
ekstrem pH , osmolaritas
Mikropartikel yang terlarut yang terbentuk
bila partikel obat tidak larut sempurna
selama pencampuran pemberian obat
intravena menggunakan filter 1 sampai 5 m.

Pemilihan material kateter intravaskuler

yang
digunakan silikon dan poliuretan kurang
bersifat
iritasi dibanding politetrafluoroetilen (teflon),
polivinil klorida atau polietilen resiko

2. PLEBITIS MEKANIS
Penempatan kateter intravaskuler
yang tidak tepat
Ukuran kateter intravaskuler yang
tidak sesuai dengan ukuran vena
Cara pemasangan, pengawasan dan
perawatan yang kurang baik
Laju pemberian yang tidak sesuai

3. PLEBITIS BAKTERIAL
Hand hygiene tidak dilakukan
Preparasi kulit tidak baik sebelum
pemasangan infus
Teknik aseptik tidak baik saat akan
pemberian obat atau cairan
Kateter dipasang terlalu lama
Tempat Tusukan Kateter tidak/ jarang
diinspeksi secara visual
Alat alat yang di gunakan rusak atau
bocor atau kadaluarsa
Larutan infus terkontaminasi karena teknik
aseptik yang kurang baik pada saat
pencampuran larutan
Faktor virulen instrinsik dari

TANDA TANDA
PLEBITIS

Secara klinis :
Ada nyeri, nyeri tekan, bengkak,
pengerasan,
eritema dan hangat pada vena
Jika infeksi :
Kemerahan, demam, sakit,
bengkak,
adanya pus atau kerusakan pada

INS Visual Infusion Phlebitis (V.I.P.)

Score, 2006
IV site appears healthy
No pain at IV site, no erythema,
No swelling
No palpable venous cord (all ages)
Erythema at access site
With or without pain
Erythema
Pain at access site
With or without edema
Erythema
Pain at access site
With or without edema
Streak formation
Palpable venous cord
Erythema
Pain at access site
With or without edema
Streak formation
Palpable venous cord > 1 inch
Purulent drainage

No
Nosigns
signsof
ofphlebitis
phlebitis
OBSERVE
CANNULA
OBSERVE CANNULA

Stop
Stopinfusion
infusionififpossible
possible
Identify
additional
Identify additionalresources
resources
for
management
for management
Remove
RemoveIV
IVififsymptoms
symptomspersist
persist

Stop
Stopinfusion
infusionififpossible
possible
Identify
additional
Identify additionalresources
resources
for
management
for management
Remove
RemoveIV
IVififsymptoms
symptomspersist
persist

Stop infusion if possible

Stop infusion if possible
Identify additional resources
Identify additional resources
for
formanagement
management
Remove IV
Remove IV
Notify primary service
Notify primary service

Stop infusion and establish alternate

Stop infusion and establish alternate
IV
IVsite
site
Remove IV and culture site and cathe
Remove IV and culture site and cath
tip
tip
Notify primary service
Notify primary service

Infiltration Scale (INS 2006)

No symptoms

Skin blanched
Edema < 1 inch in any direction
Cool to touch
With or without pain

Skin blanched

Edema 1 6 inches in any direction

Cool to touch
With or without pain

Skin blanched, translucent

Gross edema > 6 inches in any direction
Cool to touch
Mild to moderate pain
Possible numbness

Skin blanched, translucent

Skin tight, leaking
Skin discolored, bruised, swollen
Gross edema > 6 inches in any direction
Deep pitting tissue edema
Circulatory impairment
Moderate severe pain
Infiltration of any amount of blood product, irritant, or vesicant

PENATALAKSANAAN PENCEGAHAN
PLEBITIS
1.HAND HYGIENE

2. PREPARASI KULIT
Use alcohol followed by application of main
disinfectant 10% Povidone Iodine or 2%
Chlorhexidine prep.
Provides immediate kill as well as residual
activity
For Iodophor - 2-3 hrs
For Chlorhexidine prep. - 6 hrs
Process - 2 Steps
Apply alcohol in circular motion outwards,
allow it to dry
Apply Povidone Iodine or Chlorhexidine in
circular motion

3. DRESSING / PENUTUP INFUS

Use either sterile gauze or sterile
transparent,
semi permeable dressing to cover the
catheter site
Replace catheter dressing if the dressing
becomes
damp, loose, or visibly soiled
Replace dressings at every 2 days for gauze
dressing and 72 hour for transparent
CDC,
Centre for Disease Control and Prevention, Guidelines for prevention of Intravascular
dressing
catheter related Infections, MMWR, 2002: 51 ( No. RR 10 )

4.Catheter care - Flushing

All vascular access devices used should be flushed with
0.9% sodium chloride
(normal saline) or heparin to*
Maintain catheter patency
Prevent contact between incompatible fluids and medications

Appropriate Flushing helps to reduce catheter thrombosis

and thus CR-BSI risk**
As thrombi or fibrin deposits could serve as a nidus for microbial
colonization
When catheter flushing is to be performed
Just after catheter insertion
Before and after each administration of medication
od sampling
Every 6-8 hours when catheter is not in use (Once a day - home
care PICCs )
INS standards, 2006
Single use flushing systems to be used, that is, do not use
multiple use vials

5. Appropriate use of
equipment

1. Intravasular Access

Monitor and inspect catheter site regularly, the site

should be
observed for any signs of inflammation, infection or
malfunction

2.For any intravascular access

Replace IV tubing and add on devices no more frequently
than 72
hours
Replace tubing used to administer blood products or
lipids with in 24 hrs
Clean injection ports with 70% alcohol or an iodophor
before accessing

3.IVD replacement
Peripheral Venous : 72-96 hrs in adults / first signs of

The Peripheral Vascular Catheter

(PVC) Bundle
1. Performed hand hygiene before and
after all PVC procedures
2. Checking the PVCs insitu are still
requared
3. Removing PVCs where there is extra
vasation or inflamation
4. Checking PVC dressing are intact
5. Considering removal of PVCs insitu
longer than 72 hours