Tesis

Dampak Penggunaan Jangka Panjang Kateter Hemodialisis NonCuffed/Non-Tunneled Double Lumen Catheter terhadap Stenosis Vena Sentral Superior

Latar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer (noncuffed/non-tunneled double lumen catheter) jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo (RSCM). Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik (data sekunder) dengan mengambil seluruh kasus stenosis vena sentral (total sampling) dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek (63 kasus dan 63 kontrol). Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika (36 subjek, 57,14%), vena subklavia (22 subjek, 34,92%) dan vena jugularis interna (5 subjek, 7,94%). Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer (p = 0,006, OR 5,97, IK 95% 1,65–21,58), sisi pemasangan kateter di sebelah kiri (p = 0,007, OR 10,17, IK 95% 2,01–52,34) dan penggunaan kateter >2 kali (p = 0,006, OR 11,15, IK 95% 1,65–51,05). Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik (>1 minggu) yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.
Kata kunci: stenosis vena sentral, kateter hemodialisis temporer, akses vaskular


Background: The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use (non-cuffed/non-tunneled double lumen catheter) in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital (RSCM). Method: This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine-RSCM from March 2016 to July 2016. The study population was patients with stage 4-5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 20122016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records (secondary data) by taking all cases of central venous stenosis (total sampling) and control with the ratio of 1: 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows. Results: The data obtained by the research subjects were 126 subjects (63 cases and 63 controls). The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein (36 subjects, 57.14%), the subclavian vein (22 subjects, 34.92%) and the internal jugular vein (5 subjects, 7.94%). From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters (p = 0.006, OR 5.97, 95% CI 1.65 to 21.58), catheter implantation on the left side/ipsilateral to fistula (p = 0.007, OR 10.17, 95% CI 2.01 to 52.34) and the use of catheters>2 times (p = 0.006, OR 11.15, 95% CI 1.65 to 51.05). Conclusions: The use of non-cuffed/non-tunneled catheters especially in chronic condition (>1 week) which is implanted on the left side of the body/ipsilateral to fistula and with a history of >2 times catheter implantations cause central venous stenosis.
Keywords: central venous stenosis, temporary hemodialysis catheter