1. Plebitis is inflammation of the vein that can be caused by chemical, bacterial, or mechanical irritation. It is shown by redness, pain, and swelling around the infusion site or along the vein. 2. Factors that can influence plebitis include age, gender, underlying conditions, chemical irritants from medications or fluids, mechanical factors like catheter material and size, location and duration of cannulation, and infectious agents. 3. Prevention of plebitis focuses on proper hand hygiene, skin preparation before insertion, dressing care, flushing protocols, monitoring catheter sites, and replacing catheters, tubing and dressings according to evidence-based guidelines. Data collection and analysis of ph

1. PENCEGAHAN DAN PENGENDALIAN
PLEBITIS
Disampaikan
Pada Pelatihan Pemasangan Infuse
Pada tanggal 15 Februari 2020

2. POKOK BAHASAN
 Pendahuluan
 Pengertian
 Faktor –faktor yang mempengaruhi
plebitis
 Pencegahan dan pengendalian
plebitis

3. PENDAHULUAN
Pemasangan infus melalui vena perifer dapat
berisiko terjadinya plebitis
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).

4. Insiden Rate Plebitis di RSUD Lawang Tahun 2019
PARAMETER
Tahun 2019
Triwulan I Triwulan II Triwulan III Triwulan IV
Jumlah pasien plebitis N 1 4 3 81
Jumlah hari pemakaian IVL D 5.318 4.354 4399
4174
permil ‰ 0,19 0,92 0,68 19,41
Standart
‰ 1 1 1 1
Triwulan I
Triwulan II
Triwulan III
Triwulan IV
0.19 0.92
0.68
19.41
1 1 1
1
Trend Phlebitis
Tahun 2019 di RSUD Lawang Kabupaten Malang
Plebitis (‰) standart (‰)

5. PENGERTIAN
 Plebitis merupakan peradangan vena yang
disebabkan iritasi kimia, bakterial, dan mekanis yang
ditunjukkan dengan adanya daerah yang merah, nyeri
dan pembengkakan di daerah penusukan atau
sepanjang vena.
Secara klinis adanya keluhan nyeri, nyeri tekan,
bengkak, pengerasan, eritema dan hangat pada vena
oleh karena peradangan, infeksi dan/atau trombosis

6. 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 kulit

7. FAKTOR –FAKTOR YANG MEMPENGARUHI PLEBITIS
 Usia
 Jenis kelamin
 Kondisi dasar ( diabetes melitus,
infeksi, luka bakar )
 Faktor kimia seperti obat atau cairan yang
iritan
 Faktor mekanis seperti bahan, ukuran kateter,
lokasi dan lama kanulasi
 Agent infeksius

8. Catheter Related Infection Risk
Fibrin sheath,
Thrombus
HEMATOGENOUS,
From distant local Infection
Contaminated
Infusate

9. 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)
0 No signs of phlebitis
OBSERVE CANNULA
• Erythema at access site
• With or without pain 1
• Stop infusion if possible
• Identify additional resources
for management
• Remove IV if symptoms persist
• Erythema
• Pain at access site
• With or without edema
2
• Stop infusion if possible
• Identify additional resources
for management
• Remove IV if symptoms persist
• Erythema
• Pain at access site
• With or without edema
• Streak formation
• Palpable venous cord
3
• Stop infusion if possible
• Identify additional resources
for management
• Remove IV
• Notify primary service
• Erythema
• Pain at access site
• With or without edema
• Streak formation
• Palpable venous cord > 1 inch
• Purulent drainage
4
• Stop infusion and establish alternate
IV site
• Remove IV and culture site and catheter
tip
• Notify primary service

10. Infiltration Scale (INS 2006)
No symptoms 0
• Skin blanched
• Edema < 1 inch in any direction
• Cool to touch
• With or without pain
1
• Skin blanched
• Edema 1 – 6 inches in any direction
• Cool to touch
• With or without pain
2
• Skin blanched, translucent
• Gross edema > 6 inches in any direction
• Cool to touch
• Mild to moderate pain
• Possible numbness
3
• 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
4

11. JENIS – JENIS PLEBITIS
1.Plebitis Kimia
2. Plebitis Mekanis
3. Plebitis Bakterial

12. 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 µm.
 Pemilihan material kateter intravaskuler yang
digunakan  silikon dan poliuretan kurang bersifat
iritasi dibanding politetrafluoroetilen (teflon),
polivinil klorida atau polietilen resiko tertinggi

13. 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

14. 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 mikroorganisme itu sendiri

18. PENATALAKSANAAN PENCEGAHAN PLEBITIS
1.HAND HYGIENE

19. 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
outwards, allow it to dry

20. 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 dressing
CDC, Centre for Disease Control and Prevention, Guidelines for prevention of Intravascular catheter
related Infections, MMWR, 2002: 51 ( No. RR 10 )

22. 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 PICC’s )
 INS standards, 2006
 Single use flushing systems to be used, that is, do not use multiple use vials
 8% Syringes prepared by nurses are contaminated - Syringe tip, Fluid***
Touch contamination
Multiple use vials or their inappropriate usage
page 394, ** CDC, Centre for Disease Control and Prevention, Guidelines for prevention of IV catheter related Infections, MMWR, 2002: 51, Page 9 ( No. RR 10 ), ** APIC, Lynn
Hadaway, Webinar series 2006
Infusion Therapy in clinical practice Judy Hankins et al, 2nd Edition, The Infusion Nursing Society,

24. 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 phlebitis,
 In pediatric patients, Do not routinely replace peripheral venous
catheters unless clinically indicated
 CVC’s / PICC / Hemodialysis / PA / Peripheral Arterial : NOT routinely*

25. 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
NHS

26. • Pengumpulan data setiap hari
• Perhitungan setiap bulan
• Laporan setiap bulan,triwulan,semester, tahunan
• Insiden rate Plebitis:
Jumlah plebitis
--------------------------------- X 1000 = ( ‰ )
Hari pemakaian IV Kateter

28. Himpunan Perawat Pencegah dan
Pengendali Infeksi Indonesia (HIPPII)- Pusat
28

29. Replacement of Peripheral and Midline Catheters
1. There is no need to replace peripheral
catheters more frequently than every 72-96
hours to reduce risk of infection and phlebitis in
adults [36, 140, 141]. Category 1B
2. No recommendation is made regarding
replacement of peripheral catheters in adults
only when clinically indicated [142–144].
Unresolved issue
3. Replace peripheral catheters in children only
when clinically indicated [32, 33]. Category
1B
4. Replace midline catheters only when there is a
specific indication. Category II