Kasus pemasangan CVC di rumah sakit adam

mornign report

1. CVC Translated from Indonesian to English - www.onlinedoctranslator.com

2. PR/ 38 years/ 60 kg KU: Decreased consciousness Q: Complaints of decreased consciousness have been felt by the patient since 2 days. Complaints of decreased consciousness are felt slowly. There was no previous history of trauma. There was no previous history of stroke. The patient has been complaining of shortness of breath for the past 2 days. Complaints of shortness of breath are felt continuously. Complaints of shortness of breath are not related to strenuous activities, changes in position, or the weather. Cough complaints have been found since 1 month, cough accompanied by yellowish phlegm. A history of consumption of pulmonary TB drugs was found before with FDC 1X RPT: CKD Grade V RPO : - RPT: -

3. Time Sequence June 21, 2023 00.30 WIB Enter Hospital June 21, 2023 21.00 WIB CVC Installation Consultant June 21, 2023 21 05 WIB CVC installation acc June 21, 2023 21.20 WIB CVC starts

4. Physical examination in the IGD B1: Airway clear, Snoring/Gurgling/Crowing: -/-/-, SP: Vesicular +/ +, ST: Ronchi +/ +. Whezing -/-. SpO2 98% NRM 15 lpm B2: Acral: H/ M/ K, BP 85/57 HR: 94 x/ min, regular. B3: Sensorium Apathy, GCS E4M6V5 Pupil ODS Isokor Ø: 3mm, RC: +/ + B4: UOP (+) Catheter Inserted B5: Abdomen Soepel, Peristalsis (+) Normal B6: Edema (-), Fracture (-)

5. LABORATORY Hb/Ht/leu/platelets: 8.2/27.3/10.590/265.000 BUN / Ur/ Cr: 20.1/43/1.04 KGD: 155 Na/ K/ Cl: 130/2.7/95 PH/Po2/HCO3/TCO2/BE/Sao2 : 7.3/59.6/183.2/36.3/38.1/10.3/99.0

6. DIAGNOSIS Observation Convulsions + pulmonary TB on OAT + Pneumonia HAP dd CAP + HIV stage IV with Wasting Syndrome CVC Installation Consultant - Penurunan kesadaran ec TE dd Sepsis ec Pneumonia HAP dd CAP -Susp TE - HIV stadium IV dengan Wasting syndrome - TB paru on OAT Anemia ec penyakit kronik dd perdarahan (8.2)

7. Preparation Intravenous access Hemodynamic monitoring  Stethoscope Pulse oximeter Oxygenation O2 100lpm Premedication Inj muscle relaxant Intubation with ETT no 7 Listen of Lung right and left must be same Fiksation . With tape Conneting to ventilator mechine

8. Clinical Photo

9. Install CVC Position the patient Supine, support the shoulders with a cloth Identification of the landmark area to be punctured, namely in the left subclavian region Disinfect area with povidone iodine and 70% alcohol Give local anesthetic lidocaine 2% using a 1 cc syringe Insertion of a CVC needle while aspirating the venous area (+) Insert the guide wire and widen the insertion site with a dilator Insert CVC fr. 7 to a depth of 14 cm. Aspiration test (+) and back flow (+) were carried out CVC fixation was performed using mersilk cutting 2 /0 Fixation of the insertion site with hipafix.

10. Thank You

11. CVC Installation Indications When peripheral access is difficult to obtain eg in obese patients As access to entry-inclusion of vasoconstrictor drugs eg: dopamine, norepinephrine As access to hypertonic fluids eg: TPN Access to in and out of parenteral drugs that are many and long. Special things for example: hemodynamic monitoring and hemodialysis

12. Complications of CVC installation Mechanical complications, infection, thrombosis or embolism. Mechanical complications are usually a direct result of the insertion procedure and can be recognized in a short time. Atrial arrhythmias. occurs because the guide wire or catheter is too deep into the right atrium. punctured arteries, usually occurs in punctured femoral and internal jugular veins, if the subclavian artery is punctured, the bleeding that occurs is difficult to control with pressure, so it often results in extrapleural hematoma or hemothorax. Pneumothorax resulting from central venous catheterization can usually be managed with close observation and chest X-ray control, nedle troacentesis or an est tube. The presence of air in the mediastinum or subcutaneously (emphysema) is a sign of a tear in the pleura