Upload
ryankhandibrata
View
224
Download
0
Embed Size (px)
Citation preview
7/23/2019 09.00-10.00_ Clinical Update by TN
1/47
Title, Subject, Author (c) Copyright 11/08/2015
Quality Assurance Tools Adekuasi DialysisClinical Update On Hemodialysis Practice
Triningsih, S.Kep; Jakarta; 12 Agustus 2015
Clinical Manager
7/23/2019 09.00-10.00_ Clinical Update by TN
2/47
Fresenius Medical Care THE RENAL COMPANY Page 2
Agenda/ Objective
FEATURE & BENEFIT MESIN 4008 NG1
2
3
4
5
RINGKASAN
INPUT DATA PASIEN
PEMBACAAN & PENILAIAN OCM
PERAWATAN MESIN HD FMC 4008 NG
7/23/2019 09.00-10.00_ Clinical Update by TN
3/47
Fresenius Medical Care THE RENAL COMPANY Page 3
Tujuan Pembelajaran
8. Peserta Mengerti dan Memahami Produk-Produk Fresenius, dan Mengaplikasikan
Di lapangan.
7. Peserta Memahami Trouble Shooting Mesin 4008 S NG
6. Peserta Mengetahui Perawatan Mesin 4008 S NG
5. Peserta Mengetahui Feature BPM dan Operasionalnya
4. Peserta Mengetahui Cara Kerja OCM BPM dan Manfaatnya Bagi Pasien
3. Peserta Bisa Memasukkan Data Pasien dan Pembacaan OCM
2. Peserta Mengetahui Kelebihan dan Keuntungan Mesin 4008 NG
1. Peserta Mengenal Komponen Mesin 4008 NG
7/23/2019 09.00-10.00_ Clinical Update by TN
4/47
Fresenius Medical Care THE RENAL COMPANY Page 4
Pelayanan HD Mengacu Pada,.....
Melindungi pasien dalam penyelenggaraan pelayanan dialysis
yang dilakukan tenaga kesehatan. ( Peraturan MenKes RI No.
812/MENKES/PER/VII/2010 Tentang penyelenggaraan
pelayanan dialysis pada yankes)
Memberikan kepastian dan perlindungan hukum bagi
pengguna maupun penyelenggara pelayanan kesehatan.
(Konsensus Dialysis , 2003 hal 10 )
Tujuan umum pedoman pelayanan hemodialisis berorientasi
pada keselamatan dan keamanan pasien. (Pedoman
Pelayanan Hemodialisis , 2008 )
7/23/2019 09.00-10.00_ Clinical Update by TN
5/47
Fresenius Medical Care THE RENAL COMPANY Page 5
FEATURE & BENEFIT MESIN 4008 NG
7/23/2019 09.00-10.00_ Clinical Update by TN
6/47
Fresenius Medical Care THE RENAL COMPANY Page 6
MESIN HD Fresenius 4008 NG; Next Generation
Mesin HD 4008 NG
DIASAFE Bibag 5008
7/23/2019 09.00-10.00_ Clinical Update by TN
7/47Fresenius Medical Care THE RENAL COMPANY Page 7
1. User Interface (Monitor)the operator inputs treatment parameters and
receives information from the machine regarding
various aspects of the operating status
2. Extracorporeal Blood Circulation(Modules)
which pumps blood, anticoagulates blood and
monitors flows and pressures
3. Hydraulics System (Preparation ofDialysate)
the main function of which is the formationand
delivery of dialysate to the dialyzer
Feature & Benefit Mesin HD Fresenius 4008 NG
7/23/2019 09.00-10.00_ Clinical Update by TN
8/47Fresenius Medical Care THE RENAL COMPANY Page 8
Tampak Belakang
MONITOR (REAR VIEW)
SAMPLING VALVE
BRACKET / DIALYZER CONNECTION
LINES
DIALYSATE OUTLET TUBE
DIALYSATE INLET
TUBE
DIASAFE PLUS
FILTER
DISINFECTION CONNECTOR
POWER SUPPLY UNIT
VENT TUBING (OVERFLOW)
CDS RED OPTION
WATER CONNECTOR (PERMEATE)DRAIN
7/23/2019 09.00-10.00_ Clinical Update by TN
9/47Fresenius Medical Care THE RENAL COMPANY Page 9
Sistem Monitoring
Integrated Online Clearance Monitor (OCM) and BPM
Tool untuk memonitor kualitas dari dosis dialisis yang di berikan danmemastikan tingkat keamanan pasien
Plasma Na valueBPM
7/23/2019 09.00-10.00_ Clinical Update by TN
10/47Fresenius Medical Care THE RENAL COMPANY Page 10
BPM; Blood Pressure Monitor
5008 BPM
7/23/2019 09.00-10.00_ Clinical Update by TN
11/47Fresenius Medical Care THE RENAL COMPANY Page 11
Pemasangan Cuff HARUSBENAR& Searahdg
Arteri Brachialis
Size/ UkuranCuff disesuaikan
dg Pasien
Blood Pressure Module (BPM)
7/23/2019 09.00-10.00_ Clinical Update by TN
12/47Fresenius Medical Care THE RENAL COMPANY Page 12
Fully automated and non-invasive, operating on the principles ofoscillometry
Programmable measurement interval of 5 - 15 - 30 60 minutes and
quick measurement
Measurement of Systolic and Diastolic blood pressure, Mean Arterial
Pressure (MAP) and Pulse rate
Blood Pressure Module (BPM)
BPM menu now part of the monitor
7/23/2019 09.00-10.00_ Clinical Update by TN
13/47Fresenius Medical Care THE RENAL COMPANY Page 13
Bibag5008
Bibag 5008
7/23/2019 09.00-10.00_ Clinical Update by TN
14/47
Fresenius Medical Care THE RENAL COMPANY Page 14
LANJUTAN,
Penyimpanan memerlukantempat yang luas
Transportasi/
pengangkutanperlu extratenaga
7/23/2019 09.00-10.00_ Clinical Update by TN
15/47
Fresenius Medical Care THE RENAL COMPANY Page 15
PEMBACAAN & PENILAIAN OCM;
Online Clearance Monitor
7/23/2019 09.00-10.00_ Clinical Update by TN
16/47
Fresenius Medical Care THE RENAL COMPANY Page 16
Quality Assurance Tool
OCM; Online Clearance Monitor
7/23/2019 09.00-10.00_ Clinical Update by TN
17/47
Fresenius Medical Care THE RENAL COMPANY Page 17
OCM; Onlinne Clearance Monitor
Pilihan DiagramTampilan Monitor
7/23/2019 09.00-10.00_ Clinical Update by TN
18/47
Fresenius Medical Care THE RENAL COMPANY Page 18
OCM; Onlinne Clearance Monitor
Pilihan DiagramTampilan Monitor
7/23/2019 09.00-10.00_ Clinical Update by TN
19/47
Fresenius Medical Care THE RENAL COMPANY Page 19
Continuous Clearance Measurement(by Online Clearance Monitor)
Data input required
Watson formulaDry weight
Height
Age
Sex
Other parametersHematocrit (pre-set at
35%)
Measurement interval
(pre-set to 50 min.)
Set Target-Kt/V
OFFON
7/23/2019 09.00-10.00_ Clinical Update by TN
20/47
Fresenius Medical Care THE RENAL COMPANY Page 20
Babb AL, Maurer CJ, Fry DL, Popovich RP, McKee RE :The determination of membrane permeabilities and solute diffusivitieswith applications to hemodialysisChem. Eng. Progr. Symp. Ser. 84,64 (1968) 59-68
The principle of OCM is based on the equivalence of the diffusive
characteristics of the sodium ion and the urea molecule through cells and
synthetic membranes.
The Equivalence Of Electrolyte AndUrea Clearance
7/23/2019 09.00-10.00_ Clinical Update by TN
21/47
7/23/2019 09.00-10.00_ Clinical Update by TN
22/47
Fresenius Medical Care THE RENAL COMPANY Page 22
Parameters Desplayed by OCM
7/23/2019 09.00-10.00_ Clinical Update by TN
23/47
Fresenius Medical Care THE RENAL COMPANY Page 23
Reduced Clearance And The Effect on Kt/V
130
An intradialyticreduction inclearance leads
to a visualiseddecrease indelivereddialysis doseKt/V which
would remainundetectedwithout OCM.
7/23/2019 09.00-10.00_ Clinical Update by TN
24/47
Fresenius Medical Care THE RENAL COMPANY Page 24
Reduced Clearance And The Effect on Kt/V
130
An intradialytic
reduction inclearance leads to avisualised decreasein delivered dialysisdose Kt/V whichwould remain
undetected withoutOCM.
OCM allows
intradialyticcounteraction, i.e.an increase inblood flow wherepossible!
7/23/2019 09.00-10.00_ Clinical Update by TN
25/47
Fresenius Medical Care THE RENAL COMPANY Page 25
4008 S
Effective
in-vivoclearance
Plasma Sodium
concentration(corrected to
flame
photometer)
Cumulating
Kt/V
Parameters displayed by OCM
7/23/2019 09.00-10.00_ Clinical Update by TN
26/47
Fresenius Medical Care THE RENAL COMPANY Page 26
Blood samples(expensive) Kt/V >1.2 ...1.8
Dialysate; K and t,(no additional costs)
Monthly / quarterly Frequency In every session
Retrospective Quality Control Continuous, online
Staff, syringes, labtime cost and energy Effort None
Inconvenient Handling Automatic
The conventional
procedure today
Aspects With OCM option
Accuracy of K6-8% 5%
Impractical anduncommon
Quality assurance Standard!
Keuntungan Menggunakan OCM
Tidak ada tambahan atau biaya untuk
Pemantauan Kualitas yang tepat 100% untuk setiap sesi dialisis.
7/23/2019 09.00-10.00_ Clinical Update by TN
27/47
Fresenius Medical Care THE RENAL COMPANY Page 27
INPUT DATA PASIEN
7/23/2019 09.00-10.00_ Clinical Update by TN
28/47
Fresenius Medical Care THE RENAL COMPANY Page 28
GOOD RESULT
7/23/2019 09.00-10.00_ Clinical Update by TN
29/47
Fresenius Medical Care THE RENAL COMPANY Page 29
Data-data pasien untuk Penghitungan V (urea)menggunakan Rumus Waltson
7/23/2019 09.00-10.00_ Clinical Update by TN
30/47
Fresenius Medical Care THE RENAL COMPANY Page 30
Data Dialyser, QB, Waktu HD, UFG, dll
DIALYZER
HPS F.7
QB; 300Ml/Mnt
7/23/2019 09.00-10.00_ Clinical Update by TN
31/47
Fresenius Medical Care THE RENAL COMPANY Page 31
Monitoring dari waktu ke waktu
7/23/2019 09.00-10.00_ Clinical Update by TN
32/47
Fresenius Medical Care THE RENAL COMPANY Page 32
Monitoring dari waktu ke waktu
7/23/2019 09.00-10.00_ Clinical Update by TN
33/47
Fresenius Medical Care THE RENAL COMPANY Page 33
Monitoring dari waktu ke waktu
7/23/2019 09.00-10.00_ Clinical Update by TN
34/47
Fresenius Medical Care THE RENAL COMPANY Page 34
Monitoring dari waktu ke waktu
7/23/2019 09.00-10.00_ Clinical Update by TN
35/47
Fresenius Medical Care THE RENAL COMPANY Page 35
END OF DIALYSIS & RESULT OF Kt/V
7/23/2019 09.00-10.00_ Clinical Update by TN
36/47
Fresenius Medical Care THE RENAL COMPANY Page 36
BAD RESULT
d i k hi ( )
7/23/2019 09.00-10.00_ Clinical Update by TN
37/47
Fresenius Medical Care THE RENAL COMPANY Page 37
Data-data pasien untuk Penghitungan V (urea)menggunakan Rumus Waltson
7/23/2019 09.00-10.00_ Clinical Update by TN
38/47
Fresenius Medical Care THE RENAL COMPANY Page 38
Data Dialyser, QB, Waktu HD, UFG, dll
DIALYZER
HPS F.7
QB; 300Ml/Mnt
7/23/2019 09.00-10.00_ Clinical Update by TN
39/47
Fresenius Medical Care THE RENAL COMPANY Page 39
Monitoring dari waktu ke waktu
7/23/2019 09.00-10.00_ Clinical Update by TN
40/47
Fresenius Medical Care THE RENAL COMPANY Page 40
Monitoring dari waktu ke waktu
7/23/2019 09.00-10.00_ Clinical Update by TN
41/47
Fresenius Medical Care THE RENAL COMPANY Page 41
PERAWATAN MESIN HD FMC 4008 NG
Tampilan Menu Mesin 4008 S NG
7/23/2019 09.00-10.00_ Clinical Update by TN
42/47
Fresenius Medical Care THE RENAL COMPANY Page 42
System parameters OTOMATIS PROGRAM DESINFECTAN
Tampilan Menu Mesin 4008 S NG
7/23/2019 09.00-10.00_ Clinical Update by TN
43/47
Fresenius Medical Care THE RENAL COMPANY Page 43
Disinfection Program on 4008 S NG
Puristeril340/
Puristerilplus
Citrosteril/
Diasteril
Sporotal100
Sodium
Hypochlorite
3.5%
1
2
3
4
5
Disinfection
Program
7/23/2019 09.00-10.00_ Clinical Update by TN
44/47
Fresenius Medical Care THE RENAL COMPANY Page 44
Hubungan Adekuasi Dengan Kecukupan Nutrisi
Kadar bunpredialisis
turun
Nafsumakanturun
Diet rendahprotein
Adekuasiturun
malnutrisi
hipoalbuminemia
edema
Tekananonkotik
turun
UF tinggi
Hipotensi
QB turunLama HD turun
7/23/2019 09.00-10.00_ Clinical Update by TN
45/47
Fresenius Medical Care THE RENAL COMPANY Page 45
GAGAL GINJALKRONIS
Stem Cell
UremiaKekuranganMassa Ginjal
(Berbagai
Tahap)
KecenderunganBerdarah
InhibitorEritropoiesis
Colony-forming unitsErythroid (CFU-E)
Hemolisis
Hubungan Adekuasi Dengan Anemia
Eritropoietin
Osteodistrofi
Ginjal
Fibrosis
Sum-sum Tulang
Eritrosit
Malnutrisi
Keracunan Al
Def. B12
Def. Asam Folat
PTH
Fresenius Medical Care Indonesia
7/23/2019 09.00-10.00_ Clinical Update by TN
46/47
Fresenius Medical Care THE RENAL COMPANY Page 46
Fresenius Medical Care Indonesia The only Integrated Renal Company
4008S Therapy System
Low-Flux HPS Dialyser
MX EcoSeries
On-line bibag
7/23/2019 09.00-10.00_ Clinical Update by TN
47/47
THANK YOU FOR YOUR ATTENTION