diagnostik invasif jantung
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tentang diagnostik invasif jantungTRANSCRIPT
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DIAGNOSTIK INVASIF – INTERVENSI NON BEDAH[Katheterisasi jantung]
Ns. Agus Susanto Skep, CVRNDiagnostik Invasif – Intervensi non Bedah
PJN Harapan Kita Jakarta
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Diagnostik Invasif ….? Diagnostik Invasif ….?
Katheterisasi Katheterisasi jantungjantung
Penyadapan jantungPenyadapan jantung Angiography jantungAngiography jantung
“ “ Pemeriksaan Pemeriksaan diagnostik secara diagnostik secara invasif dengan invasif dengan memasukan suatu memasukan suatu katheter kedalam katheter kedalam jantung melalui jantung melalui pembuluh darah “pembuluh darah “
IVC
Ao
Ao
PASCV
RA
RV
LA
LV
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Apa yang dilakukan ..?Apa yang dilakukan ..?
PENYADAPANPENYADAPAN : : TekananTekanan SaturasiSaturasi Sistem konduksiSistem konduksi ANGIOGRAM ANGIOGRAM
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Ruang kateterisasi jantungRuang kateterisasi jantung
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Ruang Observasi(recovery room)Ruang Observasi(recovery room)
PRE POST
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Jenis tindakan Diagnostik Invasif
Penyadapan jantung kanan
Penyadapan jantung kiri
Penyadapan jantung kanan - kiri
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Grossman’s cardiac catheterization, angiography and
intervention
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Gambar arteri koroner dg Gambar arteri koroner dg angiogramangiogram
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Angiogram art koroner kanan
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Angiogram Art Koroner kiri
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Intervensi Non Bedah ….. ?Intervensi Non Bedah ….. ?
Stenosis -Stenosis - Angioplasty [Koroner, Valvuler, perifer] Angioplasty [Koroner, Valvuler, perifer] Ductus / fistel Ductus / fistel Embolisasi [PDA, ASD,VSD,AV fistel] Embolisasi [PDA, ASD,VSD,AV fistel] Aritmia Bradi -Aritmia Bradi - Pacujantung sementara/ menetap Pacujantung sementara/ menetap Aritmia Tachi tdk mengancam jiwa -Aritmia Tachi tdk mengancam jiwa - Ablasi Ablasi Aritmia tachi mengancam jiwa -Aritmia tachi mengancam jiwa - Pacujantung Pacujantung
menetap AICDmenetap AICD
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INDIKASIINDIKASI
Kelainan jantung kongenitalKelainan jantung kongenital Kelainan jantung koronerKelainan jantung koroner Kelainan jantung aritmiaKelainan jantung aritmia Kelainan jantung katupKelainan jantung katup Kelainan pembuluh darah [perifer]Kelainan pembuluh darah [perifer] Asymtomatik jantung koronerAsymtomatik jantung koroner
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Kontraindikasi (Absolut & Relatif)Kontraindikasi (Absolut & Relatif)
Kontraindikasi Absolut :Kontraindikasi Absolut : Tidak tersedianya alat angiography & Tidak tersedianya alat angiography &
SDMSDM Pasien tidak kooperatif (hiperaktifitas)Pasien tidak kooperatif (hiperaktifitas)
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KONTRAINDIKASI KONTRAINDIKASI
Usia ibu hamil < 3 bulanUsia ibu hamil < 3 bulan
Gagal jantung yang belum terdeteksiGagal jantung yang belum terdeteksi
infeksiinfeksi
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KomplikasiKomplikasi PerdarahanPerdarahan AritmiaAritmia Reaksi alergi kontrasReaksi alergi kontras Sakit dadaSakit dada EmboliEmboli TamponadeTamponade kematiankematian
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TEHNIK ANESTESI – MEMASUKAN KATHETERTEHNIK ANESTESI – MEMASUKAN KATHETER
ANESTESI :ANESTESI : UmumUmum
LokalLokal
MEMASUKAN KATHETER :MEMASUKAN KATHETER : Percutaneous /SeldingerPercutaneous /Seldinger
Cutdown / vena seksiCutdown / vena seksi
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Masalah keperawatan pre kateterisasiMasalah keperawatan pre kateterisasiGgn rasa nyaman cemasGgn rasa nyaman cemasResti inadekuat curah jantungResti inadekuat curah jantungResti inadekuat fungsi antikoagulan Resti inadekuat fungsi antikoagulan Resti infeksiResti infeksiResti perdarahanResti perdarahanResti aritmiaResti aritmiaResti perfusi jaringan periferResti perfusi jaringan periferResti ggn volume cairan kurang dari kebutuhan Resti ggn volume cairan kurang dari kebutuhan tubuhtubuh
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Asuhan keperawatan sebelum tindakanAsuhan keperawatan sebelum tindakan
FISIK :FISIK : Tanda vitalTanda vital Pemeriksaan penunjangPemeriksaan penunjang Terapi obatTerapi obat Puasa & bebaskan area Puasa & bebaskan area
penusukanpenusukan Cek pulsasi periferCek pulsasi perifer Allen test [Art Radialis]Allen test [Art Radialis] Keluhan pasienKeluhan pasien
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Lanjt’ pre tindakanLanjt’ pre tindakan
ADMINISTRASI :ADMINISTRASI : Surat izin tindakanSurat izin tindakan Surat jaminanSurat jaminan
MENTHAL :MENTHAL : Penjelasan ttg tujuan, mamfaat, resiko , Penjelasan ttg tujuan, mamfaat, resiko ,
prosedurprosedur Komunikasikan & ajarkan Komunikasikan & ajarkan dilakukan dilakukan
pasien [ tarik nafas, batuk , alergi kontras, pasien [ tarik nafas, batuk , alergi kontras, keluhan negatifkeluhan negatif
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RUANG TINDAKANRUANG TINDAKAN
Team katheterisasi :• Opretor [dokter]•Perawat [ scrub, monitoring, on lop / 3 orang]•Radiografer
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HASIL KATHETERISASI JANTUNGHASIL KATHETERISASI JANTUNG
Angiogram koroner Tekanan & saturasi
AOPA
SVC
IVC
RA
RV
LV
LA
120/80/99
25/8/15
60-70
95-100
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Angiogram LVAngiogram LV
LV sistole LV diastole
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PROSES PTCA [Percutaneous Tranlumen Coroner Angioplasty]PROSES PTCA [Percutaneous Tranlumen Coroner Angioplasty]
Jantung Koronerangiogram Angioplasty Stenting
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Koronerangiogram/koronarography
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Angioplasty
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PCI PCI (Stenting)(Stenting)
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Asuhan keperawatan setelah tindakanAsuhan keperawatan setelah tindakan
Observasi tanda vitalObservasi tanda vital Observasi perdarahanObservasi perdarahan Observasi efek alergi kontrasObservasi efek alergi kontras Observasi gangguan sirkulasi periferObservasi gangguan sirkulasi perifer Observasi hypovolemiObservasi hypovolemi Hidrasi sesuai kebutuhanHidrasi sesuai kebutuhan Observasi terjadi infeksiObservasi terjadi infeksi
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