Peripheral Intravenous Therapy:

Patient Experience
Dr. Masfuri, SKp, MN
Ketua INA-PERSAI, Mananejer Keperawatan RSUI, Dosen FIK UI

Providing Quality Training to Healthcare Professionals

Outline Presentasi
• Pendahuluan
• Data Infus (PIVC) di dunia
• Pengalaman pasien
• Aspek perbaikan ke depan
• Penutup

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Berbagai type focus model RS

THE PRODUCT Advanced care

Best outcomes
LEADER

THE Customer satisfaction

Broad network of providers THE
Low-cost care EXPERIENCE Healthy patient populations
INTEGRATOR Simpler disease management
LEADER

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INFUSION ROLE, PRACTICE & TECHNOLOGY

INFUSION THERAPIES

OTHER INFUSION DEVICES

VASCULAR ACCESS DEVICE COMPLICATIONS

VASCULAR ACCESS DEVICE MANAGEMENT

VASCULAR ACCESS DEVICE SELECTION AND PLACEMENT

INFUSION EQUIPMENT

INFECTION PREVENTION AND CONTROL

PATIENT AND CLINICIAN SAFETY

INFUSION THERAPY PRACTICE

0 10 20 30 40 50 60 70 80 90 100

TECHNOLOGY PRACTICE ROLE

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Consumer perspectives on
peripheral intravenous cannulation (PIVC)

2018. https://doi.org/10.1371/journal.pone.0193436 Providing Quality Training to Healthcare Professionals

Kesulitan Akses Intravena

Gagal 1st shoot

• D 39,8%
• A 64,0%

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Use of Short Peripheral Intravenous Catheters:
Characteristics, Management, and Outcomes Worldwide
1. Data 40,620 PIVCs in 51 countries. Primarily for medication (n = 28,571, 70%)
2. Predominantly inserted in general wards (n = 22,167, 55%)
3. Nurses inserted most PIVCs (n = 28,575, 71%)
4. Placed in non-recommended sites (hand wrist, or antecubital veins) 66%
5. The prevalence of idle PIVCs was 14% (n = 5,796).
6. Painful to the patient (symptomatic of phlebitis) 10% (n = 4,204)
7. PIVC malfunction 10% (n = 3,879)
8. PIVC dressings were suboptimal 21% (n = 8,507).
9. No documented daily site assessment 36% (n = 14,787)
10. No documented date and time of insertion 49% (n = 19,768)

10 August 2023 https://doi.org/10.12788/jhm.3039 Providing Quality Training to Healthcare Professionals

Curhatan qualitative pasien
• “It was placed right in the elbow joint region so was painful to bend
arm”; “I have become increasing difficult to cannulate … it’s now
always in tiny veins, which is painful, causes large bruising and doesn’t
last long”; and “Doctors sometimes position it in the wrist … almost
every time the wrist is bent it sets off the pump alarm–very annoying”.
• There was great difference between nurses: some had more
experience than others in insertion, but biggest difference was with
care during therapy”; “Often insertion technique is ok but management
/ maintenance thereafter is poor”
• “I have frequent blood tests and infusions with badly damaged veins.
On my most recent experience it took medical staff over 20 attempts to
insert”

J Infus Nurs. 2020 Jul; 43(4): 222–228.

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Terjemahan Online
• “Diletakkan tepat di daerah sendi siku sehingga lengan terasa nyeri saat ditekuk”;
“Saya menjadi semakin sulit untuk melakukan kanulasi… sekarang selalu berada di
pembuluh darah kecil, yang menyakitkan, menyebabkan memar besar dan tidak
berlangsung lama”; dan “Dokter terkadang meletakkannya di pergelangan tangan…
hampir setiap kali pergelangan tangan ditekuk, alarm pompa akan berbunyi – sangat
mengganggu”.
• Ada perbedaan besar di antara para perawat: beberapa perawat memiliki lebih banyak
pengalaman dibandingkan yang lain dalam hal pemasangan, namun perbedaan
terbesar adalah perawatan selama terapi”; “Seringkali teknik penyisipan baik-baik saja
tetapi pengelolaan/pemeliharaannya buruk”
• “Saya sering tes darah dan infus dengan pembuluh darah yang rusak parah.
Berdasarkan pengalaman terbaru saya, staf medis memerlukan lebih dari 20 upaya
untuk memasukkan”

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PIC Pada Pasien Anak
A systematic review: effectiveness of pediatric peripheral
intravenous catheterization strategies
• There was insufficient evidence to support the use of ultrasound,
infrared light or transillumination.
• Interventions to reduce children's pain did not decrease first
attempt success.
• Research examining between-clinician proficiency and persistence
differences is absent.

16 November 2016
https://doi.org/10.1111/jan.13211 Providing Quality Training to Healthcare Professionals
Topik Distraksi menurunkan nyeri saat insersi IV (dewasa)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357630/ Distraction technique for pain reduction

in Peripheral Venous Catheterization: randomized, controlled trial Providing Quality Training to Healthcare Professionals
Distraksi 0.69±1.26 vs EMLA 1.86±1.73

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PERBAIKAN vascular access management (VAM)

J Infus Nurs. 2020 Jul; 43(4): 222–228.

Published online 2020 Jul 9. doi: 10.1097/NAN.0000000000000377 Providing Quality Training to Healthcare Professionals
Cost saving from VAM program = 66,7%

AIVA TEAM RSUI (VAM)

DIVA SCORE 4-5

• PATIENT EXPERIENCE
• NURSE SAFETY
• HOSPITAL COST

J Infus Nurs. 2020 Jul; 43(4): 222–228.

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Effective consumer engagement

DOI: 10.4236/ojn.2018.85026 Providing Quality Training to Healthcare Professionals

Tiga hal penting why komunikasi & edukasi

Pelibatan > keputusan > proses asuhan:

• Outcomes
• Kepuasan pasien
• Adverse events

Kendala: waktu, karakteristik pasien dan

situasi klinis

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 Kenapa harus
ada interaksi dua
arah
pasien/keluarga

masfuri 19
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Perawat Memastikan RASA not only KEADAAN AMAN

https://doi.org/10.1111/jan.15044
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IV LINE BERMASALAH à BREAKING BAD NEWS
SPIKE:
1. Establish an appropriate setting.
2. Check the patient’s perception of
the situation prompting the news
regarding the illness or test
results.
3. Determine the amount of
information known or how much
information is desired.
4. Know the medical facts and their
implication before initiating the
conversation.
5. Explore the emotions raised
during the interview.
6. Respond with empathy.
7. Establish a strategy for support
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PENUTUP
• Infus (PIVC) diperlukan hampir semua pasien dirawat
• Mayoritas insersi, monitoring dan perawatan oleh perawat
• Keberhasilan (insersi, monitoring, rawatan insertion site) sangat
penting
• Strategi peningkatan pengalaman pelanggan (free pain policy),
decision making tool, assessment rutin shift/harian sangat diperlukan
• Pentingnya melibatkan pasien dan keluarga (patient centered care)
• Praktik berbasis Evidence terbaik atau menciptakan evidence terbaik
bagi pasien

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A NURSE

“So much
to do, so
little time
she has.”

masfuri 23
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Segera Terbit
Infusion Therapy Standard of Practice
Adaptasi Dalam Bahasa indonesi

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