RINGKASAN BUKU AJAR FLEBOTOMI BAGIAN PATOLOGI KLINIK FAKULTAS KEDOKTERAN UNIVERSITAS SEBELAS MARET 2012
OLEH : Dr. Elisa!"# L!$i%a Sari S!"ia%i%&r'(
P!(i(i%& : DR. )r. N*+(a% S',i- M.K!s- S.PK
PENGERTIAN FLEBOTOMI Fl!+"+(i a)ala# r+s!s !%&a(ila% )ara# )!%&a% "!/%i/ *a%& !%ar s!#i%&&a /+(+sisi a%ali"%*a isa )i!r"a#a%/a% (!lal'i $!%a- ar"!ri /ail!r. Asal /a"a )ari a#asa '%a%i *ai"' Phlebotomy Phlebotomy )ari )ari phleb3! phleb3!(' ('l'# l'# )ara# )ara# $!%a tomia3(!%&iris4(!(+"+%& tomia3(!%&iris4(!(+"+%& a)ala# i%sisi $!%a '%"'/ '%"'/ (!%&a( (!%&a(il il )ara#- 5)a#'l'6: 5)a#'l'6: venasectie. T'7'a% T'7'a% 8l!+"+(i 8l!+"+(i a)ala# '%"'/ (!%&#i%)ari (!%&#i%)ari /!sala#a% saa" !%&a(ila% )ara# *a%& )aa" (!(!%&ar'#i !(!ri/saa%. Fl!+"+(is a)ala# s!s!+ra%& *a%& (!la/'/a% 8l!+"+(i. L!&al As!/ Fl!+"+(i S!+ra S!+ra%& %& 8l!+ 8l!+"+ "+(i (iss )i la la a"a' a"a' RS 5!r 5!ra9 a9a" a"4+ 4+ra ra%& %& *a%& *a%& )ila )ila"i "i# # /#'s /#'s's 's66 (!( (!('%* '%*ai ai /!(a('a% /!(a('a% /!9!%a%&a% s!s'ai )!%&a% /+(!"!%si /+(!"!%si *a%& )i(ili/i )i(ili/i *a%& )i!r+l!# )i!r+l!# (!lal'i (!lal'i !la"i#a%- 9+r/s#+- !%)i)i/a% )ari i%s"i"'si *a%& !r9!%a%&. I%i #ar's )ila/'/a% /ar!%a "'%"'"a% (as*ara/a" *a%& s!(a/i% sa)ar #'/'( s!#i%&&a )ala( (!(!ri/a% !la*a%a% #ar's (a/si(al !as )ari /!sala#a%. Sis"!( H'/'( Sis"!( H'/'( Pi)a%a 5"i%)a/a% !%&a(ila% )ara# "a%a !rs!"'7'a% asi!%6 P!r)a"a 5"i)a/ 5"i)a/ s!%&a7a s!%&a7a a"a' s!%&a7a (!%i('l/a% (!%i('l/a% /!r'&ia% /!r'&ia% a)a asi!%6. Malra/"!/ Malra/"!/ a"a' /!lalaia% r+8!si+%al a)ala# s'a"' !la*a%a% )i a9a# s"a%)ar- "i)a/ /+(!"!% )a% (!%&a/ia"/a% /!r'&ia% a&i asi!%. #al *a%& #ar's )i'/"i/a% !%&&'&a" *ai"' : "'&as- /!lalaia%- ,i)!ras!a a/ia". I%8+r( I%8+r( ,+%s!%" 5!rs!"'7'a% 5!rs!"'7'a% (!)i/6 a)ala# a)ala# !rs!"'7'a% !rs!"'7'a% asi!% /!l'ar&a /!l'ar&a s!,ara s!,ara sa)ar '%"'/ (!%&i7i%/a% )i!ri/sa- )ila/'/a% "i%)a/a% (!)i/- )i+a"i +l!# "!%a&a /!s!#a"a% P!r!)aa% Dara# Ar"!ri- V!%aV!%a- Kail!r Dara# Dara# ar"!ri ar"!ri a%*a/ a%*a/ +/si&! +/si&!%%- !r9ar !r9ar%a %a (!ra# (!ra# "!ra%&"!ra%&- ila ila "!r+"+ "!r+"+%& %& )ara# )ara# (!%*!(r (!%*!(r+" +" /!l'ar s!ira(a )!%*'"a% 7a%"'%&. Ka%)'%&a% &l'/+sa l!i# "i%&&i- s!l )ara# '"i# (!ra#- HH" l!i# r!%)a# )ia%)i%&/a% )ara# $!%a. Biasa )ia/ai '%"'/ a%alisa &as )ara# Dara# $!%a 9ar%a l!i# "'a- a&a/ '%&'- s!)i/i" +/si&!%+/si&!%- ila "!r+"+%& "!r+"+%& )ara# /!l'ar )!%&a% alir alira% a% *a%& *a%& ra"a ra"a.. L+/a L+/asi si !%&a !%&a( (il ila% a% )ara )ara# # !r !r!% !%&ar &ar'# '# a)a a)a /+(+s /+(+sis isii )ara )ara# # $!%a. $!%a. M!%&a%)'%& H l!i# r!%)a#. Biasa !(!ri/saa% la+ra"+ri'( (!%&&'%a/a% )ara# $!%a. Dara# /ail!r "!r's !r'a# s's'%a% 9ar%a /ar!%a !r"'/ara% &as- !r)ara#a% /ail!r )i/!%al )i/!%al )ari )ari (!%&al (!%&alir%* ir%*aa )ara# )ara# !rla# !rla#a% a% /! !r('/ !r('/aa% aa%.. Ka)ar Ka)ar &l'/+s &l'/+saa l!i# l!i# "i%&&i "i%&&i-- /a)ar /a)ar +"asi'(- /alsi'(- "+"al r+"!i% l!i# r!%)a#. L!'/+si" )a% Lar&! L!',+*"! Ra"i+ 5LLR6 l!i# "i%&&i )ari $!%a. S!l )ara# (!ra#- "r+(+si"- H- H" sa(a )!%&a% $!%a.
V!%a Di F+sa ;'i"al U%"'/ T!(a" P!%'s'/a% Pili#a% !r"a(a : $.(!)ia%a ,'i"al 5)!/a" !r('/aa% /'li"- ,'/' !sar- "i)a/ "!r)aa" as+/a% sara8- ali%& s!)i/i" rasa %*!ri /!('%&/i%a% (!(ar%*a.Pili#a% /!)'a : $. ,!#ali,a 5 !sar "ai /'ra%& "!rli#a"- l!i# sa/i" )i"'s'/ )ia%)i%& $. (!)ia%a ,'i"al. Pili#a% /!"i&a : $. asili,a 5(')a# )iraa- )!/a" a.ra,#ialis sara8 (!)ia%a #ar's #a"i3#a"i6. Ji/a $!%a )i 8+sa a%"!,'i"al s'li" )ia(il : •
•
•
•
V!%a )i !r&!la%&a% "a%&a% 59i%&s %!!)l!6- "ai !%'s'/a% (!%i('l/a% rasa % *!ri- $!%a (')a# (!%&&'l'%& s'li" )aa" )ara# *a%& a%*a/. V!%a )i '%&&'%& "a%&a% V!%a )i !/s"r!(i"as a9a#- /a/i a"a' !r&!la%&a% /a/i 5 s!i7i% )+/"!r- )ila/'/a% )ia"as 1 "a#'%- "i)a/ +l!# a)a asi!% DM6 V!%a )i /!ala 5 +l!# "!%a&a *a%& "!rla"i#6 P!%&&'%aa% "+r%i/'!" 3< ,( )ia"as 8+ssa a%"!,'i"al- "i)a/ +l!# (!l!i#i sa"' (!%i" 5(!%i('l/a% #!(+/+%s!%"rasi6
P!%&a(ila% )ara# ar"!ri •
•
L+/asi : a. ra)ialis- a. ra,#ialis- a. 8!(+ralis A. ra)ialis (')a# )i)aa"- l!"a/%*a s'!r8isial- (!(ili/i /+la"!ral *a%& ai/- )aa" )!%&a% (')a# )i"!/a% ila "!r7a)i #!(a"+(a s!"!la# !%'s'/a%- s*ara" '%&si )ila/'/a% "!s All!% 536
•
A. ra,#ialis )!/a" )!%&a% sara8 (!)ia%a *a%& )aa" "i)a/ s!%&a7a "!r"'s'/
•
K!l!(a#a% a. ra,#ialis a.8!(+ralis : –
L+/asi l!i# s'li" 5l+/asi l!i# )ala( )ari a.ra)ialis6
–
M!(ili/i sir/'lasi /+la"!ral *a%& s!)i/i"
–
•
Ba%*a/ )i/!lili%&i +l!# s"r'/"'r *a%& lai% *a%& )aa" "!r"'s'/ 7i/a "!r7a)i /!sala#a% "!/%i/.
A.8!(+ralis "!rl!"a/ )i )a!ra# i%&'i%al )a% )i )a!ra# 8!(+ral "ria%&l! *a%& !risi : sara8ar"!ri- $!%a- li(8a"i/ 5#a"i3#a"i6
ANTIKOAGULAN Dia&i (!%7a)i = /!l+(+/ : –
–
–
H!ari% A%"i/+a&'la% +ral ")) )!ri8a" 3#i)r+/si s'(ari%- (isal : )i/'(ar+l- %a"ri'( 9ar8ari%- /ali'( 9ar8ari%- 8!%r+/'(+%- as!%+/'(ar+l- )!ri$a" i%)a%31.=3)i+% (isal%*a 8!%i)i+%- )i8!%a)i+%a%isi%)i+%. A%"i/+a&'la% *a%& !/!r7a )!%&a% (!%&i/a" i+% Kalsi'( JENIS ANTIKOAGULAN DAN MEKANISMENYA 1. NaEDTA atau K3EDTA
EDTA "!rs!)ia )ala( !%"'/ &ara( %a"ri'(- /ali'( a"a' li"#i'(. Ma(' (!%,!&a# )ara# )ari !(!/'a% )!%&a% (!(i%)a#/a% )a% (!%&i/a" /alsi'(- s!r"a (!(r!sii"asi +/sala" i%s+l'l!. Gara( "ri+"assi'( 5K=EDTA6 )i)is!rsi/a% )ala( !%"'/ ,aira%r!/+(!%)asi N;LS 5Na"i+%al ;+((i""!! 8+r ;li%i,al La+ra"+r* S"a%)ars6 P!ra%)i%&a% )ara# )!%&a% a%"i/+a&'la% 1-2<31->< (& !r (l )ara# a"a' 10 ,, )ara# (!%&&'%a/a% 10 (& +9)!r EDTA a"a' 0-1 ,, )ari 10? lar'"a% EDTA. Ra"i+ 1:100 50-0= ,, EDTA :=,, )ara#6 EDTA l!i# )ari 2 (& !r (l )ara# (!%*!a/a% )!&!%!rasi s!l )ara# (!ra#- !%'r'%a% #!(a"+/ri" M;V- !%i%&/a"a% M;H;- !%i%&/a"a% als' "r+(+si". EDTA )aa" )i&'%a/a% '%"'/ !(!ri/saa% )ara# r'"i%- #i"'%& s!l- #!(a"+/ri"- "!s 8ra&ili"as +s(+"i,&+l+%&a% )ara#-)ll 2. H!ari% M!/a%is(! /!r7a%*a : (!%,!&a# !(!/'a% )ara# )!%&a% (!%&#ala%&i !(!%"'/a% "#r+(i%- (!(!r,!a" !(!%"'/a% a%"i"r+(i% III )!%&a% (!%& i%a/"i8/a% 8a/"+r @a )a% (!%,!&a# !(!%"'/a% "#r+(i% )ari r+"r+(i%- (!%&i%a/"i8/a% @IIa )!%&a% ,ara (!%,!&a# "!r!%"'/%*a 8iri% s"ail. H!ari% )aa" (!%*!a/a% l!'/+si" )a% "r+(+si" ,l'(i%& )a% 9ar%a ir' a)a a,/&r+'%) l++) 8il( a)a !%&!,a"a% R+(a%+9s/*. Daa" (!%&'a a)a s'#' /a(ar a"a' => ; a)a i%,'a"+r a"a' 9a"!ra"#. Di&'%a/a% a)a !(!ri/saa% "!s 8ra&ili"as +s(+"i,- #!(+&l+i%- #i"'%& s!l- #!(a"+/ri"- &+l )ara#. =. Na"ri'( Si"ra" =-2 ? M!/a%is(!%*a )!%&a% (!%&#ila%&/a% )a% (!%&i/a" /alsi'( (!lal'i /+(l!/s /alsi'( si"ra"- (!%&#iisi a(i%+"ra%s8!ras! )a% al/ali 8+s8a"ass!- (!%s"i('li a,i) 8+s8a"as!. P!(a/aia% a%"i/+a&'la% Na Si"ra" *a%& r!%)a# a/a% (!(!%)!//a% ,l+"i%& "i(! )a% "!r7a)i /l+"- s!)a%&/a% /+%s!%"rasi "i%&&i (!%*!a/a% 8as! r+l+%&!) ,+a&'la"i% "i(!. ᵒ
Daa" )i&'%a/a% '"%'/ !(!ri/saa% /a)ar H- LED- !r#i"'%&a% s!l )ara# (!ra#&+l+%&a% )ara#-)ll. . Na"ri'( Fl+ri)! 5NaF6 U%"'/ !%&a9!" &l'/+sa )ara# /ar!%a (!%,!&a# &li/+lisis. Pa)a !%*i(a%a% s'#' /a(ar a)a 9#+l! l++) a/a% (!%'r'%/a% /+%s!%"rasi &l'/+sa a)a 1 7a( !r$ariasi )ari < ? asi!% )!9asa )a% 2? a*i ar' la#ir. <. A;D 5A,i) ;i"ra" D!"r+s!6 P!%a(a#a% )!/s"r+sa s!a&ai a#a% '%"'/ (!"a+lis( a&i !ri"r+si" s!la(a !%*i(a%a%. Ra"i+ A;D "ia 1 (l '%"'/ (l )ara# 50-><,, A;D : = ,, )ara#6. P!(a/aia% A;D )ala( "ra%s8'si )ara#- !(!ri/saa% #!(a"+l+&i. . ;PD 5;i"ra" P#+sa" D!"r+s!6 ;PDA1 5;i"ra" P#+sa" D!"r+s! A)!%i%6 B!r8'%&si s!a&ai a%"i/+a&'la% 7'&a (!r'a/a% !%&a9!" a)a /a%"+%& )+%+r )ara#. Ra"i+ ;PD )a% )ara# 1- :10 50-,, ;PD:=,, )ara#6. Fa/"+r raa%ali"i/ 8l!+"+(i •
•
M!li'"i : !rsiaa% asi!% s!!l'( !%&a(ila% s!si(!%- !%&a (ila% s!si(!%"ra%s+r" s!si(!%- !%a%&a%a% !%*i(a%a% s!si(!%. P!rsiaa% asi!% : i)!%"i8i/asi 7!las 5%a(a %+. r!/a( (!)is4 %a(a "&l la#ir6- !ri/a% i%8+r(asi "i%)a/a% *a%& a/a% )ila/'/a%. a. Ba*i : 7a&a s'asa%a %*a(a% #a%&a"- !r#a"i/a% si/+l+&is +ra%& "'a a&ar (!(a%"' "i%)a/a% . A%a/ : !rsi/a #a%&a" !rsa#aa" a&ar a%a/ "i)a/ "a/'"- !r#a"i/a% si/+l+&is +ra%& "'a ,. D!9asa : 7a&a s'asa%a %*a(a%- !ri i%8+r(asi !%&ar'# )i!"- +la# ra&a- 'asas"r!s- +sisi- &a*a #i)' 5/+i- al/+#+l6- $ariasi )i'r%al- '('r- 7!%is /!la(i%- ras/!#a(ila%.
FAKTOR ANG MEMPENGARUHI HASIL LABORATORIUM A. Di!" : )isara%/a% 'asa s!(ala( 512 7a(63/+(+sisi )ara# !r'a# s!"!la# (a/a%(!(!%&ar'#i /+l!s"!r+l )a% &l'/+sa B. Ola# ra&a : (!(!%&ar'#i #asil ,r!a"i%i% Ki%as! 5;K6- Asar"a" A(i%+ Tra%s8!ras! 5AST6- la/"a" )!#i)r+&!%as! 5LDH6- (!%i%&/a" s!"!la# a/"i8i"as ;. S"r!ss : (!%i%&/a"/a% 5CB;- al'(i%- &l'/+sa6- !%'r'%a% SI- a%+r(ali"as #+r(+% /+r"is+l- al)+s"!r+%- r!%i%- TSH- r+la/"i%. Hi!r$!%"ilasi3/!"i)a/s!i(a%&a% asa( asa )a% !%i%&/a"a% la/"a".
D. P+sisi : !%i(- r+"!i%- lii)- SI- Kalsi'( (!%i%&/a" a)a !r'a#a% +sisi. P!%&a(ila% a)a +sisi *a%& sa(a. E. Ga*a #i)' : (!r+/+/ (!%i%&/a"/a% )!%&a% ,!a" 5asa( l!(a/- !i%!8ri%- al)+s"!r+%/+r"is+l6- !%i%&/a"a% la(a" 5li+r+"!i%- a/"i8i"as !%i(- !"a%)a "'(+r- #+r(+%6. Al/+#+l- (!%i%&/a"/a% )!%&a% ,!a" /a)ar &l'/+sa- la/"a"- asa( 'ra" !r'a#a% la(a" !%i%&/a"a% &a((a &l'"a(il "ra%s8!ras! 5GGT6- AST- Ala%i% A(i%+ Tras8!ras! 5ALT6- "ri&lis!ri)a- /+r"is+l. F. Variasi )i'r%al : (!r'a/a% 8l'/"'asi ,aira% "''# )ala( s!#ari. P!%i%&/a"a% a&i #ari A;TH- TSH-T )a% !%'r'%a% !+si%+8il a&i #ari. G. Fa/"+r i%"ri%si/ : '('r- 7!%is /!la(i%- ras- /!#a(ila% (!(!%&ar'#i r!%"a%& %ilai. P!rsiaa% !%&a(ila% s!si(!% : A.
Ala" #ar's !rsi#- /!ri%&- "i)a/ (!%&a%)'%& )!"!r7!%- a#a% /i(ia-
B.
Ta'%& "i)a/ !,a#- r!"a/- (')a# )i'/a )aa" )i"'"' raa"
;.
L+/asi !%&a(ila% )is!s'ai/a% )!%&a% s!si(!% *a%& )i!rl'/a%. Dara# $!%a 5$.(!)ia%a ,'i"i- $.,!ali,a- $.asili,a6- )ara# ar"!ri 5 a.ra,#ialis4a.8!(+ralis6- )ara# /ail!r 5 '7'%& 7ari "!%&a#47ari (a%is a&ia% "!i a"a' )a!ra# "'(i" 14= a&ia% "!i "!laa/ /a/i a)a a*i.
D.
Ca/"' !%&a(ila% s!si(!% :
S!ai/%*a a&i #ari )ala( /!a)aa% asal
P!(!ri/saa% *a%& (!(!rl'/a% 'asa- s!"!la# 12 7a( "i)a/ +la# ra&a
P!(!ri/saa% '%"'/ (!(a%"a' !%&+a"a% )i!r"i(a%&/a% /a)ar '%,a/ s!"!la# (i%'( +a" 8as! s"!a)* s"a"! s!!l'( !(!ria% )+sis !ri/'"%*a
P!%&a(ila% )ila/'/a% s!!l'( a)a !%&ar'# "!rai
U%"'/ (alaria )ia(il a)a a/#ir !ri+)! )!(a(
U%"'/ !(!ri/saa% (i/r+8ilaria )ia(il a)a "!%&a# (ala(.
ANTIKOAGULAN Ta'%& *a%& )ir!/+(!%)asi/a% CHO :
No
Tipe tabu! " #a$a %a!
A&i'ti(
)a$a 'e$*a
Ke!uaa
1
2 =
&i!ua'a B+"+l /'l"'r )ara# 59ar%a /'%i%& &aris #i"a(6
Ta'%& %+% a)i/"i8 Ta'%& /+a&'lasi 5"'"' ir' "!ra%&6 Kl+" a/"i8a"+r 5"'"' (!ra#6
Br+"# (i"'r!
M!%7a&a $iaili"as (i/r++r&a%is(!
Mi/r+i+l+&i/'l"'r a!r+a%a!r+- 7a('r
S+)i'( si"ra" Kl+" a/"i8a"+r
M!%&i/a" /alsi'(
T!s /+a&'lasi 5PT4aPTT6 Ki(ia- s!r+l+&ii('%+l+&i- ,r+ss (a",# U%"'/ /a)ar li"#i'( (!%&&'%a/a% s+)i'( #!ari%'%"'/ /a)ar a((+%i'( (!%&&'%a/a% s+)i'( a"a' li"#i'( #!ari% H!(a"+l+&i a%/ )ara# 5,r+ss (a",#6 T!s DNA- HLA"!s a"!r%i"as
Dara# !/' )is!%"ri8's! '%"'/ !(!ri/saa% s!r'( S+)i'( M!%+%a/"i8/a% #!ari% a"a' "#r+(i% )a% li"#i'( "#r+(+las"i% #!ari%
<
S+)i'( #!ari% 5"'"' #i7a' "'a6
EDTA 5"'"' '%&'6
EDTA
M!%&/#!lasi /alsi'(
>
Ta'%& )ara# 5"'"' /'%i%& ',a"6
D!"r+s! asa( si"ra"
I%a/"i8asi /+(l!(!%
P!%&a(ila% s!si(!% : "!/%i/ !%&a(ila% #ar's )ila/'/a% )!%&a% !%ar a&ar "!r#i%)ar )ari /!sala#a% : •
T!/a%a% "+r%i/'!" "!rlal' la(a
•
P!%&a(ila% )ara# "!rlal' la(a 5"i)a/ s!/ali "'s'/6
•
H+(+&!%isasi )ara# )!%&a% a%"i/+a&'la% "i)a/ s!('r%a
•
P!%&a(ila% )ara# a)a 7al'r i%8's
Tra%s+r" s!si(!% : o
P!%&iri(a% )!%&a% ,ara "!a" (!%7a(i% /'ali"as sa(!l- (!%&&'%a/a% 9a)a# /#'s's 5/+"a/4"as /#'s's )ari a#a% las"i/4&a's *a%& )aa" )i"'"' raa" (')a# )ia9a
o
P!%'%)aa% )aa" s!la(a 2 7a(
o
P!%'%)aa% la(a a/a% (!%*!a/a% !%'r'%a% /a)ar %a"ri'(- &l'/+sa- 7'(la# l!'/+si"- "r+(+si"- !r'a#a% (+r8+l+&i s!l )ara#- PT4APTT (!(a%7a%& !%i%&/a"a% Kali'(- 8+s8a"- LDH- !r/!(a%*a a/"!ri.
P!%&!l+laa% s!si(!% :
Pr!s!%"ri8's!
S!%"ri8's!
P+s" s!%"ri8's!
P!%*i(a%a% s!si(!% : 7i/a !(!ri/saa% )ir!%,a%a/a% )i"'%)a a"a' )ir'7'/ /! la r'7'/a%- la(a !%*i(a%a% #ar's (!(!r#i"'%&/a% 7!%is !(!ri/saa%- s"aili"as s!si(!%- 9a)a# s!si(!%. Ca/"' !%*i(a%a% sa(!l Jei+ pe,e$i'+aa Ki(ia /li%i/ I('%+l+&i #!(a"+l+&i K+a&'lasi T+/si/+l+&i Bl++) &r+'i%&
#a'tu Mi%&&' I Mi%&&' I Ja( 2 Hari I Mi%&&' Mi%&&' I
te,pat R!8ri&!ra"+r R!8ri&!ra"+r S'#' /a(ar R!8ri&!ra"+r R!8ri&!ra"+r R!8ri&!ra"+r
TEKNIK FLEBOTOMI Fl!+"+(i $!%a- la%&/a#3la%&/a# : 1. I)!%"i8i/asi asi!% )!%&a% 7!las 2. J!las/a% r+s!)'r *a%& )ila/'/a% =. Sia/a% +sisi asi!%- isa )')'/ a"a' !rari%& . Sia/a% ala" : 7ar'(- #+l)!r- "a'%&- sar'%& "a%&a%- "+r%i'!"- /aas al/+#+l- /aas4/asa s"!ril- l!s"!r- "!(a" !('a%&a% 7ar'( <. La/'/a% #a%) #i&i!%!- a/ai sar'%& "a%&a% . Pasi!% )is'r'# (!%&&!%&&a( >. ;ari $!%a- ili# "!(a" *a%& "i)a/ s!ri%& )ia(il . G'%a/a% "+r%i/'!"
. D!si%8!/si )!%&a% al/+#+l >0?- /!ri%&/a% 10. Fi/sasi $!%a )ia9a# "!(a" "'s'/a% )!%&a% i' 7ari- 7ari "!%&a# )a% 7ari "!l'%7'/ 11. Mas'//a% 7ar'( )!%&a% '7'%& 7ar'( (!%&#a)a /! a"as- a(il )ara# /ira3/ira 2 )ari *a%& )i!rl'/a% '%"'/ a%alisis sa(!l 12. L!as/a% "+r%i'!" s!&!ra saa" )ara# ('lai (as'/ )ala( s'i"- 7a%&a% (!%,a'" 7ar'( ila "+r%i'!" (asi# "!rasa%&. 1=. S!"!la# sa(!l )ara# *a%& )ia(il ,'/'- asi!% )i(i%"a (!l!as/a% /!ala% "a%&a% !la%3!la% 1. L!"a//a% /aas s"!ril- "ari/ 7ar'(- "!/a% /aas4 /asa )ia"as "!(a" !%'s'/a% '%"'/ (!%&#!%"i/a% !r)ara#a% 1<. S!"!la# !r)ara#a% !r#!%"i !ri l!s"!r 1. ,a('r4+la/3ali/ !la% "a'%& *a%& (!%&a%)'%& a%"i /+a&'la% 1>. B!ri la!l a)a "a'%& 1. B'a%& 7ar'( a)a "!(a" !('a%&a% 7ar'(.
Fl!+"+(i ar"!ri T'7'a% : !(!ri/saa% &as )ara# 5a.ra)ialis6 H )ara# '%"'/ (!%&!"a#'i s"a"'s r!sira"+ri's /!s!i(a%&a% asa( asa )ala( "''#- /a)ar O2- ;O2 )ala( )ara# a)a !%*a/i" ar'- !%*.(!"a+lis(! !%*.lai%%*a s!r"a )i&'%a/a% s!a&ai !&a%&a% )ala( asi!% !%*a/i" !ra" *a%& a/'" (!%a#'%. 5)ara# i%i (!%&&a(ar/a% (!"a+lis(! a)a s!('a +r&a% s#& /+(+sisi )ara# sa(a )is!('a 7ari%&a% "''#6 I%)i/asi : a. U%"'/ (!%ilai "!/a%a% ar"ial O2 ;O2 )ala( )ara# . U%"'/ (!%ilai H )ara# ,. P!(!ri/saa% a%alisa &as )ara#- iasa%*a )ila/'/a% a)a asi!%3asi!% &a%&&'a% !r%a8asa% !ra" *a%& a/'" ). P!%&'/'ra% H )ara#- "!/a%a% ar"ial ;O2O2 (!(!ri/a% i%8+r(asi *a%& a/'ra" "!%"a%& s"a"'s /!s!i(a%&a% asa( asa )a% !r"'/ara% &as )ala( "''#
!. A%alisa &as )ara# 7'&a )i'"'#/a% ila a/a% (!la/'/a% ;O3+i(!"ri '%"'/ (!%ilai methenoglobinemia carboxyhemoglobinemia K+%"rai%)i/asi 8l!+"+(i ar"!ri : a.
D!8isi!%si sir/'lasi /+la"!ral !/s"r!(i"as a"as a&ia% )is"al
.
Ti)a/ "!raa%*a )!%*'" ar"!ri ra)ialis
,.
T!s All!% +si"i8
).
P'%&si ar"!ri ra)ialis s!ai/%*a "i)a/ )ila/'/a% a)a asi!% )!%&a% i%8!/si /'li" 5s!l'li"is6
!.
Pasi!% *a%& (!%)aa" "!rai a%"i/+a&'la% 5&a%&&'a% /+a&'lasi6
8.
Bypass grafting T!s All!% 1. Palasi )!%*'" ar"!ri ra)ialis 'l%aris a)a !r&!la%&a% "a%&a% 2. T!/a%4"'"' alira% )ara# ar"!ri 'l%aris ra)ialis =. Pasi!% )is'r'# (!%&&!%&&a( /'a" "a%&a%%*a s!la(a =0 )!"i/ '%"'/ (!%&+s+%&/a% alira% )ara# )i "a%&a% . S!"!la# =0 )!"i/- asi!% )is'r'# (!l!as/a% &!%&&a(a%%*a- (a/a "!laa/ "a%&a% a/a% "a(a/ ',a" <. L!as/a% "!/a%a% a)a a.'l%aris . Pa)a /+%)isi %+r(al "!laa/ "a%&a% a/a% /!(ali (!(!ra# )ala( 9a/"' <310 )!"i/ s!"!la# "!/a%a% )il!as/a%. Hal i%i (!%a%)a/a% 8'%&si ar"!ri 'l%aris a"!% 5"!s all!% %!&a"i86. Ji/a "!laa/ "a%&a% "!"a ',a" (!l!i#i 9a/"' "!rs!'"- (!%a%)a/a% a)a%*a +/l'si a)a ar"!ri 'l%aris a"a' &a%&&'a% /+la"!ral 'l%aris Ala" )a% a#a% a. E$a,'a"!) ,+ll!,"i+% "'!- 7ar'(- #+l)!r . S*ri%&! %+ 2=32< ,. T'"' s*ri%&! *a%& !risi #!ari% li"i'( /!ri%& ). T+r%i'!" !. Kaas al/+#+l
8.
Pl!s"!r
&. Sar'%& "a%&a% #. Ca)a# !('%&a% 7ar'( i.
Li)+/ai% 1?
7.
Ka%"'%& !s
T!/%i/ "'s'/a% ar"!ri 1. P!r&!la%&a% "a%&a% asi!% )i+sisi/a% "!rl!%"a%& 5 )i!/s"!%si/a%6 a&ar a.ra)ialis a)a +sisi l!i# )a%&/al )aa" "!rli#a" 7!las. 2. L!"a//a% &'l'%&a% #a%)'/ )ia9a# !r&!la%&a% "a%&a% '%"'/ (!(!r"a#a%/a% +sisi =. ;',i "a%&a% s!s'ai r+s!)'r .
Pa/ai sar'%& "a%&a%- i)!%"i8i/asi s!('a /+(+%!%
<. Palasi '%"'/ (!%,ari r+,!ss's s"*l+i)!'s +s ra)i's .
Palasi )a!ra# 8l!+r "!%)+% ,ari ra)i's- s!!la# (!)ia% r+,!ss's s"*l+i)!'s +s ra)i's
>. A.ra)ialis !ra)a )ia%"ara r+,!ss's s"*l+i)!'s +s ra)i's )a% "!%)+% 8l!+r ,ari ra)ialis . Palasi )!%*'" %a)i "!%"'/a% "i"i/ i('ls (a/si('( . Pa)a /as's a.ra)ialis *a%& s'li" )ialasi 5(is.!)!(a $as+sas(!6 )i&'%a/a% USG )+l!r 10. Lal'/a% a%as"!si l+/al "'%&&' =030 )!"i/ 11. Ar"!ri *a%& a/a% )i"'s'/ )is"!ril/a% )!%&a% al/+#+l >0? )ii/'"i )!%&a% *+)i'(&'%a/a% '/.1320 G- "'s'/a% 7ar'( )!%&a% l'a%& (!%&#a)a /! alira% )ara#/!(iri%&a% =03< 5a.ra)ialis6- 0 5a.8!(+ralis6 ᵒ
12. P'lsasi )ara# /! )ala( s*ri%&! (!%'%7'//a% )ara# )ari ar"!ri- iar/a% "!risi s!%)iri s+%"a%4asi8- ila ')ara "'r'" "!rasirasi (a/a 7ar'( #ar's )i,a'" lal' )i"'s'/ la&i. 1=. Isi s'i" )!%&a% )ara# 132,,. Ji/a )ara# "i)a/ )i!r+l!# 7a%&a% (!%ari/ l'%&!r- "ari/ 7ar'( s!,ara !rla#a% sa(ai #a%*a )ia9a# /'li" 'la%&i r+s!)'r. 1. S!"!la# s*ri%&! "!risi )ara#- ,a'" 7ar'(- "!/a% )!%&a% /asa4 /aas /!ri%& s"!ril (i%i(al 2 (!%i" 5 )ia%7'r/a% < (!%i"6 lal' )i"'"' 1<. B'a%& &!l!('%& ')ara a)a 7ar'( s'%"i/
1. ;a('r sa(!l )ara# )!%&a% li"#i'( #!ari% '%"'/ (!%,!&a# !/' 1>. B!ri la!l 5%a(a- %+.RM4ala(a"6 1. Ji/a !rl' )isi(a%- )i(as'//a% )ala( /a%"'%& !s. P'%&si a.ra,#ialis •
M!r'a/a% ili#a% /!)'a '%"'/ a%alisa &as )ara#
•
P!%'s'/a% #ar's #a"i3#a"i /ar!%a l!"a/ )!/a" sara8 (!)ia%a
•
T!/%i/ : l!%&a% )ala( /!a)aa% l'r's )a% r+"asi a)a !r&!la%&a% "a%&a%- /!(')ia% raa 'ls! ar"!ri a)a )a!ra# 8+ssa a%"!,'i"al- !%'s'/a% )!%&a% s')'" < ᵒ
P'%&si a.8!(+ralis •
•
Raa a.8!(+ralis "!a" )ia9a# "i"i/ "!%&a# li&a(!% i%&'i%al Mas'//a% 7ar'( )!%&a% s')'" 0 /! ara# 'lsasi ar"!ri '%"'/ s!/ali !%&a(ila% )ara# ar"!ri. U%"'/ !%!(a"a% /a"!"!r- 7ar'( )i(as'//a% )!%&a% s')'" < (!%&#a)a /! a"as. ᵒ
ᵒ
•
Nilai r'7'/a% a%alisa &as )ara# : –
H %+r(al >-=<3>-<
–
Pa;O2 %+r(al 2<3< ((H&
–
PaO2 %+r(al 03100 ((H&
–
T+"al ;O2 )ala( las(a %+r(al 23=1 (E4l
–
Bas! !/s!s %+r(al 32- s4) 2-=
–
Sa"'rasi O2 l!i# )ari 0?
K+(li/asi 8l!+"+(i ar"!ri •
N*!ri
•
Eis+)! $as+$a&al
•
A%!'ris(a a.ra)ialis
•
P!r)ara#a%
•
I%8!/si
•
Sas(! ar"!ri
•
P!rl'/aa% a)a $!%a4sara8
•
Is/!(ia a)a "a%&a%
•
H!(a"+(a *a%& (!%*!a/a% si%)r+(a /+(ar"!(!% )a% (!"a+lis(!
•
•
•
T!/a%a% ar"ial /ar+%)i+/si)a- /+%s!%"rasi i/ar+%a" %ilai H- (!%'%7'/a% a)a4 "i)a/%*a asi)+sis !r%a8asa% (!"a+li/ ri(!r a"a' (i!) a"a' al/al+sis T!/a%a% ar"ial +/si&!%- (!%'%7'//a% /!lai%a% a)a /a)ar +/si&!% )ara# )a% a)a "i)a/%*a #i+/s!(ia P!(!ri/saa% BGA- )aa" )ia/ai '%"'/ !%!&a//a% )ia&%+sis &a%&&'a% asa( asa )a% /!&a&ala% #i+/s!(ia !r%a8asa%.
Fl!+"+(i a)a %!+%a"!s •
PRAANALITIK –
Ala" a#a% : •
–
P!rsiaa% %!+%a"'s +ra%& "'a •
•
–
•
Al/+#+l >0?- sar'%& "a%&a% s"!ril- 9i%&!) ,+ll!,"i+% 5B'""!r8l*6- la%,!" %!9 +r%-$a,'%"ai%!r ,+ll!,"i+% "'!- #a%)'/ /+(r!s !%&#a%&a""+r%i'!"- "!(a" 'a%& 7ar'(
Ba*i )il!"a//a% )i!r('/aa% )a"ar- )i!)+%& ;i"a/a% s'asa%a %*a(a%- #a%&a" '%"'/ a*i s!r"a a&ar +ra%& "'a isa !/!r7asa(a
P!rsiaa% !"'&as
LOKASI PENGAMBILAN DARAH KAPILER )o&itio A&! C!i&#" Pla,!(!%" +8 la%,!"
R!,+(!)!) 8i%&!r
-ee P$i/' Bir"# "+ a+'" (+%"#s Fr+( =310 /&- ar+i(a"!l* O% "#! (!)ial +r la"!ral la%"ar
N+" ali,al!
Fi!e$ P$i/' O$!r (+%"#s Gr!a"!r "#a% 10 /& O% si)! +8 "#! all +8 "#! s'r8a,! 8i%&!r !r!%)i,'lar "+ "#! li%!s +8 "#! 8i%&!rri%" S!,+%) "#ir) 8i%&!r 5i.!. (i))l! si%& 8i%&!r6- a$+i) "#! "#'( i%)! 8i%&!r !,a's! +8 ,all's!s a$+i)
"#! li""l! 8i%&!r !,a's! "#! "iss'! is "#i%
•
•
-ee p$i/' 5a)ala# !%&a(ila% )ara# a)a sa(!l )i "'(i" /a/i a&ia% la"!ral a"a' (!)ial63r!/+(!%)asi CHO- !r#a"i/a% /!)ala(a% "'s'/a% "i)a/ +l!# l!i# )ari 2- (( '%"'/ a*i r!(a"'r )a% la%,!" 0-< (( /!)ala(a%%*a /ar!%a )a!ra# "'(i" "!r)aa" %!r$'s la%"aris "'la%& /al/a%!'s 53isa (!%i('l/a% /!r'sa/a% %!r$'s +s"!+(i!li"is6
ANALITIK •
T's'/a% )a!ra# /'li" : •
•
•
•
La/'/a% )!si%8!/si )!%&a% al/+#+l- "'s'/ )!%&a% la%,!" #a(ir "!&a/ l'r's !r('/aa% /'li" 5/!)ala(a% 2- ((6 B'a%& "!"!sa% !r"a(a )!%&a% /aas s"!ril- /'('l/a% s!si(!% )ala( "a'%& s"!ril- !ri la!l
P!%&a(ila% )ara# )ari )a!ra# "'(i" : •
Pas"i/a% i)!%"i"as asi!%
•
G'%a/a% #a%) s,+!%
•
La/'/a% !%&#a%&a"a% )!%&a% #a%)'/ a"a' a%"ala% 2 ; s!la(a =3< (!%i" '%"'/ (!%i%&/a"/a% alira% )ara# ᵒ
•
D!si%8!/si la"!ral la%"ar !)is- /!ri%&/a% )!%&a% /aas
•
T's'/ )!%&a% la%,!" %!9 +r%- "i)a/ +l!# 2-((
•
•
Pili# l+/asi *a%& "!a" 5a%"!,'i"i- )+rs'( !)is- $!%a /!ala6
Dara# !r"a(a /!l'ar )i'a%&- !rsi#/a% )!%&a% /aas /!ri%&- )i"a('%& )ala( "a'%& )ala( +sisi "!&a/ l'r's.
P!%&a(ila% )ara# )ari )a!ra# /!ala : •
Biasa )ila/'/a% a)a $. "!(+ralis s'!r8isialis a"a' $!%a lai% *a%& (!('%&/i%/a% )ia(il )ara#%*a
•
;',i "a%&a%- &'%a/a% #a%) s,+!%
•
;'/'r ra('" a*i )!%&a% isa' s"!ril
•
G'%a/a% A2=3A2< 5'""!r8l* s!"6
•
Raa 'lsasi $!%a
•
T!(a"/a% /ar!" &!la%& )i a&ia% a"as /!ala 7i/a s'li" (!raa /!ala
•
•
•
Pasa%& 7ar'( s'%"i/ )!%&a% l!('" asirasi !rla#a% '%"'/ (!%,!&a# #!(+lisis )ara# a"a' +/l'si )i%)i%& $!%a. L!"a//a% /aas s"!ril lal' s!&!ra l!as/a% 7ar'(. T!/a% /aas !!raa saa"- lal' l!s"!r 1< (!%i". Ja%&a% (!%ari/ 7ar'( s!!l'( /ar!" &!la%& )il!as.
P!%&a(ila% )ara# )ari '(ili,'s : •
Masi# /+%"r+$!rsi- /ar!%a (asi# !r,a('r )!%&a% )ara# i'
•
Biasa )i&'%a/a% '%"'/ !(!ri/saa% &!%!"i/
•
U%"'/ !(!ri/saa% la+ra"+ri'( (asi# )ira&'/a% /!a/'ra"a% #asil%*a.
PAS;AANALITIK •
•
P!r#a"i/a% /!a)aa% asi!% s!"!la# !%'s'/a%- a)a%*a !r)ara#a%- #!(a"+(a K+(li/asi : +s"!+(i!li"is- ,!ll'li"is- as!s- /!r'sa/a% 7ari%&a%- /!r'sa/a% sara8 ar'" s/ar a)a "'(i"
FLEBOTOMI PADA ANAK •
PERSIAPAN ANAK ORANG TUA –
•
Har's ra(a#- !rsa#aa"- i)!%"i8i/asi 7!las- 7!las/a% "!/%i/ *a%& a/a% )ila/'/a% )!%&a% /a"a3/a"a *a%& )i(!%&!r"i- /!"!rlia"a% +r"' (!%&'ra%&i /!,!(asa% a%a/r'a%&a% *a%& %*a(a%
PERSIAPAN ALAT –
G'%a/a% ala" *a%& )i(+)i8i/asi s!#i%&&a "i)a/ (!%a/'"/a% 'a" a%a/ 5a/aia% l!s"!r- !ri/a% '7ia%6
POSISI ANAK •
•
B'"'# a%"'a% +r"' '%"'/ (!%a#a% +sisi a%a/- )!%&a% +sisi $!r"i/al 5)ia%&/' i'6 )a% #+ri+%"al 5!rari%&6 P!(a/saa% )aa" (!%*!a/a% "ra'(a si/is
•
M!%&'ra%&i %*!ri –
•
M!%,!&a# !%'lara% !%*a/i" –
–
•
D!%&a% a%as"!si "+i/al- EMLA 5E'"!"i, Mi"'r! +8 L+/al A%as"!"i,s6- ,a('ra% li)+/ai% r+/ai% )i+l!s/a% a)a /'li" i%"a/
Pa)a a%a/ )i r'a%& is+lasi '"'# ala" r+"!/si )iri '%"'/ (!%,!&a# !%'lara% !%*a/i" Casa)a a)a a%a/ )!%&a% al!r&i /ar!"- la"! 5si%a i8i)a- /!lai%a% /+%&!%i"al "ra/"'s 'ri%ari's- %!'r+&!%i, la)!r6
Pri%si 8l!+"+(i a)a a%a/ : –
H!!l s"i,/ )ila/'/a% a)a '('r 0 'la%
–
Fi%&!r s"i,/ $!%i'%,"'r! - '('r 'l%3 2 "a#'%
–
V!%i'%,"'r!- '('r 2 "a#'%.
Mi,r+,aillar* s/i% '%,"'r! S/i%'%,"'r! a)ala# r+s!s !%&a(ila% sa(!l )ara# (!lal'i "'s'/a% /'li" '%"'/ (!%)aa"/a% )ara# /ail!r.Dila/'/a% ila 7'(la# )ara# *a%& )i'"'#/a% s!)i/i"- (is: !ri/sa /a)ar &l'/+sa- H- H"- a%alisa &as )ara# 5,ailar* (!"#+)6.Dara# *a%& )ia(il ila "!rlal' a%*a/ a/a% (!%*!a/a% a%!(ia a)a a*i. L+/asi !%&a(ila% a)a a%a/ )a% a*i : Ba*i4%!+%a"'s l!i# )is'/ai a)a "'(i" *ai"' (!)ial4la"!ral la%"ar- )asar !r('/aa% "'(i" s!ai/%*a )i&'%a/a%
•
A%a/ 1 "a#'%- !r('/aa% al(ar '7'%& 7ari III4IV
•
Pla%"ar 7ari /a/i 7ara%& )i&'%a/a% )a% #a%*a '%"'/ a%a/ 1 "a#'% P!%'s'/a% a)a 7ari : )ila/'/a% a)a a%a/ 1 "a#'%. T!(a" "!rai/ )i 7ari /!"i&a a"a' /!!(a" Hal *a%& "i)a/ +l!# )ila/'/a% a)a !%'s'/a% 7ari : •
•
P!%'s'/a% a)a sisi la"!ral4 '7'%& )ari 7ari- /ar!%a l+/asi i%i (!%&a%)'%& s!)i/i" 7ari%&a% l'%a/- "!r)aa" !('l'# )ara#- sara8 )!/a" "'la%& P!%'s'/a% s!7a7ar )!%&a% si)i/ 7ari 5 8i%&!r ri%"s6 /ar!%a )aa" (!%&!%ai "'la%&
•
•
Dila/'/a% a)a a*i- /ar!%a 7ari%*a a%*a/ (!%&a%)'%& sara8 s!#i%&&a (!%i('l/a% %*!ri a)a 7ari !r"a(a a%*a/ (!%&a%)'%& ar"!ri. P!%'s'/a% a)a 7ari *a%& (!%&ala(i sia%+sis- "!raa )i%&i%- "!raa )i%&i%- 7ari%&a% ar'"/!(!ra#a% )a% !%&/a/- !r)ara#a%.
V!%i'%,"'r! a)a %!+%a"!s •
P!%'s'/a% $!%a )ila/'/a% ila (!(!rl'/a% )ara# *a%& l!i# a%*a/ '%"'/ !(!ri/saa%
•
P!%'s'/a% a)a $!%a )i 8+ssa a%"!,'i"al- )ila/'/a% a)a a%a/ 2"a#'%
•
•
•
Pa)a %!+%a"'s !%'s'/a% a)a $.)+rsal (a%'s !r&!la%&a% "a%&a%- sisi lai% (!)ial !r&!la%&a% "a%&a%- )+rs'( /a/i- /'li" /!ala (!)ial !r&!la%&a% /a/i V!%i'%,"'r! )iili# a)a %!+%a"'s /ar!%a rasa sa/i" s!)i/i"- )ia%)i%&/a% "'(i". Hi%)ari $!%i'%,"'r! a)a a%a/ a"a' a*i )!%&a% i%8's a"a' IV li%!- #i%)ari !/s"r!(i"as a"a' )a!ra# !)!(a-#i%)ari !%'s'/a% a)a !%)!ri"a #!(+8ilia a"a' /!lai%a%
FLEBOTOMI PADA DECASA Di%)i%& ar"!ri (!%7a)i a"#!r+s/l!r+sis- a&ia% )ala( !(. Dara# /asar- "!r)aa" !%'('/a% /+l!s"!r+l )a% /alsi'(. Biasa )i&'%a/a% $!%a )i )a!ra# 8+ssa a%"!,'i"al- a"a' "a%&a%4 !r&!la%&a% "a%&a%- isa 7'&a )i /a/i 5ili#a% "!ra/#ir6. L+/asi *a%& "i)a/ +l!# )ila/'/a% a)a '%&si )ara# : a. L!%&a% a)a sisi (as"!/"+(i . Da!ra# E)!(a4 $!%a *a%& $aris!s ,. H!(a"+(a ). Da!ra# !/as l'/a !. Da!ra# )!%&a% ,a%%'la- 8is"'la 4 ,a%&/+/a% $as/'l!r 8. Da!ra# *a%& "!rasa%& "!rai IV li%! P!%&a(ila% )ara# /ail!r- )ila/'/a% a)a :
P!('l'# )ara# *a%& (')a# ra'#
Pasi!% *a%& #a%*a (!(!rl'/a% 7'(la# )ara# s!)i/i"
Pasi!% *a%& (!(!rl'/a% !(!ri/saa% !r'la%&
•
•
Pasi!% )!%&a% l'/a a/ar4ar'" a)a "!(a" !%&a(ila% )ara# $!%a
Pasi!% *a%& sa%&a" &!('/
Pasi!% *a%& (!%)aa" "!rai IV a)a /!)'a "a%&a%%*a
Pasi!% *a%& (!(ili/i /+(li/asi s!ri's a/ia" $!%i'%,"'r!
Ti)a/ +l!# )ila/'/a% a)a : K!a)aa% )!#i)rasi !ra"- sir/'lasi *a%& 'r'/- &a%&&'a% /+a&'lasi- !(!ri/saa% *a%& (!(!rl'/a% 7'(la# )ara# *a%& !sar L+/asi !%&a(ila% )ara# /ail!r : a. a)a '7'%& 7ari "a%&a%- "!li%&a- "'(i" . Ti)a/ +l!# a)a )a!ra# $as+/+%s"i/si- $as+)ila"asi- /+%&!s"i- sia%+sis
FLEBOTOMI PADA GERIATRI M!"+)a !%'s'/a% /'li" a"a' /ail!r- 9i%& %!!)l!- )!%&a% "a'%& $a/'( (!r'a/a% al"!r%a"i8 ili#a% "!r&a%"'%& /+%)isi 8isi/. T's'/a% /'li" a"a' /ail!r )ila/'/a% /ar!%a !%iisa%4 !%'r'%a% !las"isi"as /'li"- !%&a(ila% l!i# s'li" /ar!%a $!%a (+il! )a% (')a# "!r7a)i #!(a"+(a- l!i# s'li" )i"'s'/ /ar!%a a"!r+s/l!r+"i/. •
•
P!r(asala#a% *a%& s!ri%& a)a 8l!+"+(i &!ria"ri : •
P!%&li#a"a% (!%'r'%3)i!ri/a% a%)'a% saa" !%&a(ila% )ara#
•
P!%)!%&ara% (!%'r'%3!%&'la%&a% i%s"r'/si- i,ara )!/a" "!li%&a
•
P!%'r'%a% i%)!ra !%&!,aa%- !%,i'(a%- !rasa3(al%'"risi
•
L!(a#%*a +"+"3,!%)!r'%& (!%7a"'#/a% s!s'a"'
•
P!%'r'%a% )a*a i%&a"3l'a /aa% "!ra/#ir (a/a%
•
Jari%&a% s'/'"a% !i"!l (!%7a)i l!i# "iis
•
Masa +"+" l!i# s!)i/i"
•
;!%)!r'%& #i+"!r(ia
•
P!%i%&/a"a% s!%si"i$i"as al!r&i
Hal3#al *a%& !rl' )i!r"i(a%&/a% a)a !ra9a"a% r'(a# : •
B'"'# !rs!)iaa% ala" !/s"ra '%"'/ )ia9a
•
•
P+sisi %*a(a% 5!rsa%)ar4ari%&6 Fl!+"+(is !ra)a )!/a" /a(ar (a%)i 5(')a# ,',i "a%&a% a"a' (!(a9a #a%)r'6
•
S!si(!% *a%& )i)aa" )i "!(a"/a% )ala( 9a)a# a%"i+,+r )i!ri la!l
•
Ca/"' !%&a(ila% )i,a"a" )!%&a% ai/- ila !%'%)aa%
FLEBOTOMI DENGAN ANASTESI TOPIKAL •
A%as"!si /ri( : li)+,ai%4r+,ai% /ri( 5EMLA6 –
–
EMLA : E'"!,"i, Mi"'r! +8 L+,al A%as"!"i,s6 : &a'%&a% li)+,ai% 2-
'eebi0a
'e'u$a!a
A(a% )i&'%a/a% a)a a%a/3a%a/
E8!/ a%as"!si ('%,'l s!"!la# 1 7a( )iali/asi
Pr+s!s (')a#
M!%&&'%a/a% !%'"'
EMLA )aa" (!%i('l/a% !8!/ a%as"!si sa(ai 7a(
K'ra%& !8!/"i8 )i&'%a/a% a)a !r('/aa% /'li" *a%& "!al E8!/ sa(i%& la%,#i%&- !ri"!(a
•
•
A%as"!si &!l : A(!"#+,ai%! &!l 5A(!"+ &!l6- (!r'a/a% &!l *a%& (!%&a%)'% & "!"ra,ai% ?- s!"!la# )i&'%a/a% !r('/aa% /'li" #ar's )i"'"' )!%&a% las"i/ 8il( K!l!i#a% /!/'ra%&a% a%as"!"i/ &!l
Keebi0a A%as"!si *a%& !8!/"i8
Ke'u$a!a Har's (!%&&'%a/a% !%'"'
Ca/"' ali/asi l!i# si%&/a" 5<(!%i"6
E8!/ sa(i%& !ri"!(a- /'li" (!(',a"- &a"al !)!(a 57ara%&6
E8!/ a%as"!si la(a 5 7a(6 M!r'a/a% a%as"!si *a%& a(a%
E8!/ sis"!(i/ "i)a/ a)a
•
•
A%as"!si a",# : li)+,ai% a"a' "!"ra,ai%! a",# 5SNERA6- ri%si (!l!as/a% rasa a%as a)a /'li" s!#i%&&a (!%i%&/a"/a% !%*!raa% +a". M!%&a%)'%& > 0(& li)+,ai% "!"ra,ai% >0 (& K!l!i#a% /!/'ra%&a% a%as"!si a",#
'eebi0a
'e'u$a!a
;ara !(a/aia% (')a#
M!%i('l/a% rasa a%as s!!r"i "!ra/ar
A(a% !8!/"i8
Ti)a/ )ia%7'r/a% !%&&'%aa% ('l"il! s*%!ra a",#!s
Daa" )i&'%a/a% a)a a%a/3a%a/- +ra%& )!9asa la%sia B!l'( a)a !8!/ sis"!(i/
•
A%as"!si Sra* : 8l'+ri3M!"a%a Sra* 5Va+,+ala%" sra*6- "i)a/ (')a# "!ra/ar(!%*!a/a% !%)i%&i%a% s!(!%"ara !r('/aa% /'li"- )ia/ai )!%&a% (!%&&'%a/a% +la /aas- iar/a% ,aira% (!%&'a )a% )i'sa )!%&a% al/+#+l EMLA K$i,
AMETOP !e
SYNERA Pat/0
Ca/"' *a%& )i'"'#/a% D'rasi
M!%i" 0
M!%i" =03<
M!%i" 20
apo/oaat +p$a% D!"i/ 0
Ja(
Ja(
Ja( 2
D!"i/ 1<
M!%&&'%a/a% !%'"'
E8!/ sa(i%&
Bla%,i%& Eri"!(a 'r'ra
Eri"!(a Ga"al !)!(a
Rasa a%as s!!r"i "!ra/ar
Rasa "!ra/ar a)a asi!% 'sia 12 "a#'%
PENYULIT DAN KOMPLIKASI TEKNIK SULIT PADA FLEBOTOMI T!r7a)i a)a asi!% l'/a a/ar- asi!% *a%& "!rasa%& &is- !)!(a- #!(a"+(a- asi!% +s" (as"!/"+(i- asi!% )ialisis- asi!% *a%& s!)a%& (!%!ri(a "ra%s8'si asi!% *a%& "!rasa%& i%8's. B!!raa /+%)isi asi!% *a%& (!(!%&ar'#i 8l!+"+(i a)ala# asi!% )ala( !%&+a"a% a%"i/+a&'la% )a% s!)a%& (!%!ri(a /+a&'la%. FAKTOR KHUSUS 1. PASIEN ANAK A%a/ )')'/ )ia%&/'- "!(a"/a% l!%&a% +ra%& "'a )is!/!lili%& a%a/ )ia"as l!%&a% *a%& "i)a/ )i&'%a/a%. L!%&a% *a%& lai% (!(a%"' l!%&a% *a%& a/a% )i'%&si $!%a )ari !la/a%& a)a l!/'/a% si/'- 7i/a a%a/ !rari%& (a/a +r"' !rsa%)ar )ia"as a%a/ a)a sisi s!!la# "!(a" "i)'r. 2. PASIEN ORANG TUA
P!r'a#a% a)a /'li"- /'ra%&%*a !las"isi"as /'li"- !%'r'%a% /!l!(aa% s!#i%&&a /'li" (')a# l'/a )a% ra'# )a% /+las !('l'# )ara#
P!%)!%&ara% (!(+ri ('lai (!%'r'%
B!r/ai"a% )!%&a% !%*a/i" s"r+/!-ar/i%s+%- ar"#ri"is- )ia!"!s- (!(a/ai /'rsi r+)a
=. PASIEN ANG SULIT BERKOMUNIKASI
K!"!ra"asa% a#asa
Pasi!% *a%& is' "'li
Pasi!% *a%& /+(a
Pasi!% )!%&a% &a%&&'a% !(+si+%al- a&r!si8- /!lai%a% 7i9a
. PASIEN ANG MENOLAK FLEBOTOMI
Kar!%a "a/'" (!(a/ai 7ar'( /!,il a%al&!"i/ "+i/al
B'7'/ asi!% 7!las/a% )!%&a% ai/
Ja%&a% (!(a/sa/a% "i%)a/a% a)a asi!%
;a"a" !%+la/a% a)a r!/a( (!)is
PEMILIHAN ALAT M!"+)! "!rai/ '%"'/ (!%)aa"/a% s!si(!% a)a '%&si $!%a a)ala# (!"+)a "a'%& $a,'( a"a' !$a,'a"!- *a%& "!r)iri )ari = /+(+%!% *ai"' "a'%& $a/'( '%"'/ sa(!l- 7ar'( a)a 2 "i"i/ 5sa"' '%"'/ (as'/ /! $!%a- '7'%& *a%& sa"' '%"'/ /! )ala( "a'%& $a/'(6 )a% las"i/ !(!&a%&. Ci%& %!!)l! )a% s*ri%&! /a)a%& )i&'%a/a% '%"'/ asi!% )!%&a% !('l'# )ara# /!,il )a% ra'#. T!rs!)ia '/'ra%2132<- '/'ra% 21-2= l!i# ai/ )ari 2< /ar!%a '/'ra% /!,il (!%*!a/a% #!(+lisis /!"i/a )ara# )ia(il. KOMPLIKASI FLEBOTOMI S*%,+!- P!%&a(ila% )ara# &a&al- H!(a"+(a- P!"!/ia- E,!ssi$! l!!)i%&- K+(li/asi %!'r+l+&i,- K!r'sa/a% !('l'# )ara#- H!(+/+%s!%"rasi- H!(+lisis- $+(i""i%& H!(a"+(a a)a 8l!+"+(i T!r/'('l%*a )ara# )ala( 7ari%&a% a"a' r+%&&a- !rasal )ari !,a#%*a !('l'# )ara#ar"!ri- $!%a a"a' /ail!r. T!r7a)i /ar!%a ar!a "'s'/a% (!l!ar- (!%*!a/a% /!+,+ra% )ara# /! 7ari%&a%. Jar'( (as'/ "!rlal' )ala(- (!l!9a"i $!%a a"a' s')'" (iri%& s!#i%&&a (!('a" )i%)i%& $!%a "!r'/a.P!%a%&a%a% #!(a"+(a saa" ('lai "!r!%"'/- 7ar'( "+r%i/'!" #ar's ,!a" )il!as- )a!ra# #!(a"+(a )i"!/a% s!la(a 2 (!%i"- 7i/a !r)ara#a% !rla%&s'%& "!r's #ar's )i"a%&a%i l!i# la%7'". K+(r!s !s (!%i('l/a% $as+/+%s"ri/si s!#i%&&a (!%&'ra%&i !r)ara#a% !(!%&/a/a%. El!$asi (!%&is"ira#a"/a% l!%&a% )aa" (!%&'ra%&i !%&/a/ )a% (!%&#i%)ari /!r'sa/a% l!i# la%7'". N*!ri as,a 8l!+"+(i M!r'a/a% 7!%is %*!ri sara8 *ai"' %*!ri *a%& "!rasa a)a "!(a" !%*'%"i/a%4 iri"asi (!%7alar s!a%7a%& a&ia% )is"al%*a- *a%& )is!a/a% /ar!%a a)a%*a sara8 *a%& "!r&+r!s +l!# 7ar'( saa" !%'s'/a% $!%a a"a' /ar!%a "!/a%a% )ari #!(a"+(a *a%& s')a# a)a s!!l'(%*a. N*!ri *a%& (!%7alar (!r'a/a% %*!ri *a%& a/ia" !ra%&sa%&a% "!r#a)a sara8 s!%s+ri/ !ri8!r. J!%is %*!ri a)ala# 7!%is %!'ri"is 7!a/a% a"a' !%"ra(!%" % !'ri"is- "!r7a)i &a%&&'a% sara8 !ri8!r )!%&a% (a%i8!s"asi !r'a &a%&&'a% s!%s+ri/ (+"+ri/. Ha(ir s!('a %*!ri *a%& (!%7alar )ari si/' /! '7'%& 7ari "a%&a% (!r'a/a% %!'ri"is 7!a/a% )ari %.ra)ialis %. 'l%aris a/ia" r!'(a"is('s )a!ra# si/' P!%,!&a#a% ,ara (!%&#i%)ar %*!ri : •
M!%a%*a/a% ri9a*a" 8l!+"+(i s!!l'(%*a- aa/a# a)a /+(li/asi *a%& "i('l
•
M!%&a(il )ara# a)a $!%a *a%& !%ar3!%ar )i*a/i%i isa )ila/'/a% !%'s'/a% )!%&a% (!(i%i(alisir &!ra/a% 7ar'( *a%& (as'/ /! $!%a
•
G'%a/a% 7ar'( *a%& "a7a( s!#i%&&a "!a" /! $!%a
•
Hi%)ari !%&a(ila% a)a l+/asi "!a" )isisi la"!ral )ari "!%)+ ('s,'l's is!s ra,#ii sisi (!)ial )ari (.ra,#i+ra)ialis /ar!%a "!(a" i"' "!rl!"a/ %!r$'s ,'"a%!'s a%"!ra,#ii la"!ralis
•
Dir!/+(!%)asi/a% !%&a(ila% a)a $.(!)ia%a ,'i"i4 $!%a a)a l!%&a% a9a#- /ar!%a l!"a/%*a s'!r8isial )a% "i)a/ !r)!/a"a% )!%&a% sara8 !sar.
