Tesis

Faktor risiko yang memengaruhi catheter related bloodstream infection pada pasien yang menjalani hemodialisa menggunakan non cuffed catheter : studi kohort historikal berdasarkan durasi pemakaian = Risk factors influencing catheter related bloodstream infection in patients who undergoing hemodialysis using non cuffed catheter: historical cohort study based on duration of use.

Latar Belakang: Secara insidensi, statistik akses vaskular di pada tahun 2009 di Amerika Serikat adalah: 81,8% dengan kateter vena sentral (CVC). KDOQI juga menyarankan pengunaan non cuffed catheter untuk jangka waktu sementara ( < 2 minggu), namun pada kenyataan nya di Indonesia, masih banyak penderita HD yang menggunakan non cuffed catheter > 2 minggu. Metode: Desain penelitian yang digunakan adalah desain kohort historikal. Penelitian dilakukan di Rekam Medis Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo, Jakarta periode Januari 2021 sampai dengan November 2023. Dilakukan uji bivariat dan multivariat pada data yang didapat. Hasil: didapatkan 262 sampel penelitian dengan 39 (14.9%) sampel yang mengalami CRBSI dan 223 (85.1%) sampel yang tidak mengalami CRBSI. Variabel yang meningkatkan risiko terjadinya CRBSI adalah durasi pemasangan kateter > 2 minggu (p < 0,001), durasi rawat inap > 7 hari (p < 0,001) , lokasi kateter di femoral (p = 0,005), dan lokasi tindakan bedside (p < 0,001). Dari uji multivariat didapatkan durasi pemasangan kateter > 2 minggu memiliki peningkatan risiko mengalami CRBSI sebesar 14 kali lipat dibanding durasi  2 minggu. Durasi rawat inap > 7 hari memiliki risiko 71 kali lipat mengalami CRBSI dibanding durasi  7 hari. Lokasi kateter di femoral memiliki peningkatan risiko mengalami CRBSI sebesar 10 kali lipat dibanding lokasi di jugular. Lokasi tindakan bedside memiliki peningkatan risiko mengalami CRBSI sebesar 54 kali lipat disbanding tindakan di ruang operasi. Kesimpulan: Angka kejadian CRBSI pada penderita yang menjalani hemodialisa dengan non-cuffed catheter durasi ≤ 2 minggu secara bermakna lebih rendah dibandingkan durasi > 2 minggu. Faktor yang mempengaruhi kejadian CRBSI pada penderita yang menjalani hemodialisa dengan non-cuffed catheter adalah lokasi tindakan pada bedside, lokasi pemasangan kateter pada vena femoralis, dan lamanya rawat inap > 7 hari.
Kata kunci: infeksi aliran darah berhubungan dengan kateter, kateter non cuffed


Backgrounds: In terms of incidence, vascular access statistics in 2009 in the United States were: 81.8% with central venous catheters (CVC). KDOQI also recommends using non-cuffed catheters for a temporary period ( < 2 weeks), but in reality in Indonesia, there are still many HD sufferers who use non-cuffed catheters for > 2 weeks. Methods: The research design used was a historical cohort design. The research was conducted in the Medical Records of the National Central General Hospital, dr. Cipto Mangunkusumo, Jakarta for the period January 2021 to November 2023. Bivariate and multivariate tests were carried out on the data obtained. Results: There were 262 samples with 39 (14.9%) samples with CRBSI and 223 (85.1%) samples without CRBSI. Variables that increase the risk of CRBSI are duration of catheter placement > 2 weeks (p < 0.001), duration of hospitalization > 7 days (p < 0.001), femoral catheter location (p = 0.005), and bedside procedure location (p < 0.001) . From the multivariate test, it was found that a duration of catheter placement > 2 weeks had an increased risk of experiencing CRBSI by 14 times compared to a duration of 2 weeks. A duration of hospitalization > 7 days has a 71 times greater risk of having CRBSI than a duration of 7 days. Femoral catheter locations have increased risk of having CRBSI by 10 times compared to jugular locations. Bedside procedures have increased risk ofhaving CRBSI by 54 times compared to procedures in the operating room. Conclusion: The incidence of CRBSI in patients undergoing hemodialysis with a noncuffed catheter for a duration of ≤ 2 weeks is significantly lower than for a duration of > 2 weeks. Factors that influence the incidence of CRBSI in patients undergoing hemodialysis with a non-cuffed catheter are the location of the procedure at the bedside, the location of the catheter in the femoral vein, and the length of stay > 7 days.
Keywords: catheter related bloodstream infection, non cuffed catheter