PROBLEM OF CENTRAL VENOUS

CATHETER IN HEMODIALYSIS
PATIENTS
T.SY.ULTRA MARINA
RENAL UNIT HIPERTENSI RSUP HAJI ADAM MALIK MEDAN
TAHUN 2018
Guideline 2: Selection and Placement of Hemodialysis Access

 The radiocephalic fistula is the vascular access of preference

followed by the brachiocephalic fistula, transposed brachiobasilic
fistula, and lastly an arteriovenous synthetic graft.

 Long-term dialysis catheters should be avoided, particularly on

the same side of a maturing venous access. Long-term femoral
dialysis catheters should not be placed on the same side as a future
renal transplant.

 Right internal jugular vein is the preferred site for tunneled cuffed
venous dialysis catheters. Subclavian veins should be used only
after all other upper extremity sites are exhausted.

KDOQI 2006
• GUIDELINE 3: CANNULATION OF FISTULAE AND GRAFTS AND ACCESSION OF
HEMODIALYSIS CATHETERS AND PORT CATHETER SYSTEMS

• PROPER TECHNIQUES FOR SKIN PREPARATION AND CANNULATION OF VENOUS ACCESS ARE
IMPORTANT IN CONTROLLING INFECTION, INCLUDING THE USE OF ASEPTIC TECHNIQUE AND
REGULAR CHANGING OF CATHETER DRESSINGS AT DIALYSIS.

• VASCULAR ACCESS SITES SHOULD BE EXAMINED VISUALLY, WITH A STETHOSCOPE, AND BY

PALPATION. IN THIS MANNER, A STENOSIS OR INFECTION AFFECTING THE ACCESS SITE MAY
BE DETECTED. AN ARTERIAL STEAL SYNDROME MAY ALSO BE UNCOVERED.

KDOQI 2006
AKSES VASKULAR MERUPAKAN SALAH SATU FAKTOR

PENTING DALAM PROSES PEMBERIAN TERAPI

HEMODIALYSIS

MORBIDITAS DAN MORTALITAS

 PERMASALAHAN AKSES VASKULAR PADA DASAR
TERBAGI DUA MEDIS DAN NON MEDIS

MASALAH MEDIS : 1. EDUKASI MENGENAI TPG PADA PASIEN GGK

DENGAN GFR > 30ML/MNT/1,73 M
SAAT PASIEN AKAN MENJALANI HD PERLUNYA
VASKULAR TERPASANG LEBIH AWAL.
2. KEGAGALAN AKSES VASKULAR
3. KOMPLIKASI AKSES VASKULAR
MASALAH NON MEDIS : MELIPUTI BIAYA DAN TEKNIK OPERASI
 AKSES VASKULER

• TAHAPAN PENTING SEBELUM MEMULAI SESI HD

• UNTUK MEMAKSIMALKAN JUMLAH DARAH YANG DIBERSIHKAN
SELAMA HD, AKSES HARUS MEMUNGKINKAN DENGAN VOLUME
ALIRAN DARAH YANG BESAR, BERULANG & KONTINYU
• RULE OF 6 SIX : FLOW > 600 ML/MIN, DIAMETER > 0,6 CM, DPT
DIAKSES < 0,6 CM DI BAWAH KULIT.
• IDEALNYA AKSES HARUS DIPERSIAPKAN BEBERAPA MINGGU-
BULAN SEBELUM MEMULAI THERAPI SUPAYA HD SEMAKIN
EFISIEN, MUDAH, DAN MEMINIMALKAN KOMPLIKASI
http://kidney.niddk.nih.gov
KDOQI.vascullar access.pdf
 THERE ARE III TYPES OF VASVULAR ACCES

• NATIVE ARTERIO VENOUS FISTULA (AVF)

• PROSTHETIC ARTERIO VENOUS GRAFT (AVG)
• CATHETER :

 TEMPORARY DOUBLE LUMEN CATHETER

 PERMANENT CATHETER
 CDL PADA PASIEN HD AKUT MERUPAKAN AKSES YANG SANGAT DI
BUTUHKAN, MASALAH YANG DI JUMPAI :

 VOLUME DARAH YANG BANYAK TERBUANG

 TINGKAT INFEKSI YANG TINGGI
 SERING ALIRAN DARAH TIDAK LANCAR
 TERJADI STENOSIS
 PNEUMOTHORAKS
 EMBOLI UDARA
 TIDAK DAPAT DI GUNAKAN DALAM WAKTU PANJANG
ANATOMY
Vascular Access via Percutaneous Catheters

Non-cuffed catheters Cuffed catheters

Vascular Access via Percutaneous Catheters

 PERCUTANEOUS CATHETERS

• INFEKSI • TROMBUS
• STERIL PROSEDUR
• HINDARI MENYENTUH LANGSUNG DG TANGAN DAERAH EXIT SITE DAN
• UJUNG ARTERI DAN VENA, PAKAI KASA STERIL
• (BERSIHKAN DAERAH EXIT SITE DAN UJUNG ARTERI DAN VENA
• DENGAN KASS STERIL/ ALKOHOL)
• JAGA EXIT SITE TETAP KERING DAN BERSIH
• ASPIRASI BLOK HEPARIN A-V CATH
• BILAS A-V CATH DG NS ± 20 CC
• JANGAN DIBILAS BILA CATH SUMBAT
 HEPARIN LOCK

The Standard procedure for maintaining patency between dialysis treatment has
been heparin instilation (1000 to 10.000 U/ml) into the lumens in a volume
sufficient to fill to the lumen tip (the lock)

Locking with lower heparin concrentrations (2500 or 1000 U.ml) prevent catheter
thrombosis as efficiently as 5000 U/ml

The American Society of Diagnostic and Interventional Nephrology Clinical

Practice Commitee recommends using a locking solution of 1000 U/ml heparin to
maintain tunneled dialysis catheters patency
• RADIOCEPHALIC FISTULA

• BRACHIOCEPHALIC FISTULA

• BRACHIOBASILIC FISTULA

•
 KOMPLIKASI AV FISTULA

 INFILTRASI/HEMATOMA

 PSEUDO ANEURISMA/ANEURISMA

 STENOSIS

 TROMBOSIS

 STEAL SYNDROME

 INFEKSI
 JANGAN MEMUTAR2 NEEDLE  JANGAN DIKANULASI
 BILAS FISTULA DG NS  NEEDLE TRAUMA
 TEKAN DG 2 JARI 10-12 MENIT  STENOSIS
 NAIKKAN TANGAN DIATAS
JANTUNG
 ISTIRAHATKAN FISTULA
 KOMPRES ES
Anastomosis

Pulse Thrill Weak or no thrill

INFEKSI
ULTRASOUD
GUIDE
 THANK YOU

• AUGUST 2018

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• 081260051919
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