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    Av Shunt PP

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    wahyuartyningsih
    1. An arteriovenous (AV) shunt is a surgical connection between an artery and vein to facilitate hemodialysis by providing vascular access. 2. The first successful AV shunt was created in 1959 by Quinton and Scribner by connecting an artery and vein externally using PVC tubing. Brescia and Cimino further developed the technique of permanent vascular access in 1966. 3. The AV shunt procedure involves surgically connecting the radial artery to the cephalic vein at the wrist, as recommended by KDOQI guidelines from 2000, to provide vascular access for hemodialysis treatments.

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    Av Shunt PP

    Uploaded by

    wahyuartyningsih
    79 views34 pages
    1. An arteriovenous (AV) shunt is a surgical connection between an artery and vein to facilitate hemodialysis by providing vascular access. 2. The first successful AV shunt was created in 1959 by Quinton and Scribner by connecting an artery and vein externally using PVC tubing. Brescia and Cimino further developed the technique of permanent vascular access in 1966. 3. The AV shunt procedure involves surgically connecting the radial artery to the cephalic vein at the wrist, as recommended by KDOQI guidelines from 2000, to provide vascular access for hemodialysis treatments.

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    1. An arteriovenous (AV) shunt is a surgical connection between an artery and vein to facilitate hemodialysis by providing vascular access. 2. The first successful AV shunt was created in 1959 by Quinton and Scribner by connecting an artery and vein externally using PVC tubing. Brescia and Cimino further developed the technique of permanent vascular access in 1966. 3. The AV shunt procedure involves surgically connecting the radial artery to the cephalic vein at the wrist, as recommended by KDOQI guidelines from 2000, to provide vascular access for hemodialysis treatments.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    79 views34 pages

    Av Shunt PP

    Uploaded by

    wahyuartyningsih
    1. An arteriovenous (AV) shunt is a surgical connection between an artery and vein to facilitate hemodialysis by providing vascular access. 2. The first successful AV shunt was created in 1959 by Quinton and Scribner by connecting an artery and vein externally using PVC tubing. Brescia and Cimino further developed the technique of permanent vascular access in 1966. 3. The AV shunt procedure involves surgically connecting the radial artery to the cephalic vein at the wrist, as recommended by KDOQI guidelines from 2000, to provide vascular access for hemodialysis treatments.

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    of 34

    TKV TIM

    INSTALASI BEDAH SENTRAL


    RSUD.DR SAIFUL ANWAR
    MALANG
    DEFINISI
    • Berasal dari huruf A : arteri dan
    V vena dan shunt : sambungan
    • Suatu tindakan pembedahan
    dgn cara menghubungkan arteri
    dan vena sebagai akses dialisis
    (cuci darah)
    Sejarah
    • “Quinton-Scribner Shunt” menghubungkan
    arteri dan vena perifer dengan menggunakan
    pipa PVP diluar kulit oleh Quinton dan
    Scribner tahun 1959

    • Brescia dan Cimino tahun 1966


    Mengembangkan teknik “Permanent vascular
    access”
    LOKASI BEDAH
    Berdasarkan KDOQI guideline th 2000
    1. A. Radialis – V. Cefalika (Bresia Cimino)
    2. A. Brachialis – V. Cefalika
    3. A. Brachialis – V. Basilika
    4. Bahan sintetik A-V Graft
    KONTRAINDIKASI
    1. LOKASI VENA YG PERNAH
    DILAKUKAN PENUSUKAN DALAM
    WAKTU DEKAT
    2. VENA YG MENGALAMI KALSIFIKASI/
    TERDAPAT ATHEROMA
    3. TES ALLENT : ALIRAN ARTERI
    ABNORMAL
    TEST ALLENT
    • The hand is elevated and the patient is asked
    to clench their fist for about 30 seconds.
    • Pressure is applied over the ulnar and the
    radial arteries so as to occlude both of them.
    • Still elevated, the hand is then opened. It
    should appear blanched (pallor may be
    observed at the finger nails).
    • Ulnar pressure is released while radial
    pressure is maintained, and the colour should
    return within 5 to 15 seconds.
    If color returns as described, Allen's test is considered to be normal. If color fails
    to return, the test is considered abnormal and it suggests that the ulnar
    artery supply to the hand is not sufficient. [2] This indicates that it may not be safe
    to cannulate or needle the radial artery.
    TEKNIK OPERASI
    PERSIAPAN INSTRUMEN
    BASIC SET
    1. Doek klem :3
    2. Desinfeksi klem :1
    3. Pinset “bebek” chirugis :2
    4. Pinset “bebek” anatomis :2
    5. Gunting matzemboum :1
    6. Gunting benang :1
    7. Hand mess no 3 :1
    8. Hand mess no 7 :1
    9. Mosquito klem :2
    10. Pean sedang :2
    11. Nald foeder :1
    12. Hak kombinasi /sein miller :2
    Extra set
    1. Pinset anatomis vaskuler :2
    2. Klem 90° :1
    3. Gunting vaskuler :1
    4. Nald foeder vaskuler :1
    5. Buldog klem :1
    6. Santinski :1
    7. Sprider(k/p) :1
    8. Tegel (surgical loop) :1
    9. Rubber shod :1
    Bahan habis pakai
    1. Ns 0,9% 500cc :1
    2. Heparin : 1 cc
    3. Pehacain / lidocain : 6 ampul
    4. Spuit 10 cc, 3 cc : 2, 1
    5. Betadin : 100 cc
    6. Kasa, depers : 10, 5
    7. Hand Couter :1
    8. Handscoen :5
    9. Underpad steril :3
    10. Benang prolen 4-0, :1
    11. Benang prolen 7-0 doble jarum :1
    12. Benang ziede 3-0 :1
    13. Supratule :1
    14. NGT no 5 / abocath no 18/20 :1
    PERSIAPAN PASIEN
    a) SURAT PERSETUJUAN OPERASI
    b) SIDE MARK
    c) MENGATUR POSISI PASIEN
    TERLENTANG DENGAN SALAH SATU
    TANGAN DIATAS MEJA MAYO
    PERSIAPAN LINGKUNGAN
    1. MEJA OPERASI
    2. LAMPU OPERASI
    3. MEJA LINEN
    4. MEJA MAYO
    5. MESIN COUTER
    6. MESIN SUCTION
    7. BEDSIDE MONITOR
    8. PERALATAN OKSIGENASI
    9. TEMPAT SAMPAH
    10.TEMPAT DUDUK
    TEHNIK ISTRUMENTASI
    1. Surgical scrub, gowning, gloving
    2. Antiseptik area operasi
    3. Draping area operasi
    4. Pasang hand coute dan cek fungsi
    5. Marking area operasi
    6. Injeksi local anastesi pada area
    operasi
    Marking untuk insisi cimino
    Berikan anestesi
    lokal. Setelah
    infiltrasi berikan
    pinset Chirrugie.
    Insisi
    menggunakan
    mess 15
    perdalam
    dengan diatermi
    couter
    Mencari vena
    pinset anatomis, mosquito dan
    sein miller
    Tegel vena
    surgical loop biru
    Membebaskan
    vena distal
    proximal dengan
    mosquito / gunting
    metzemboum, jika
    ada cabang vena
    ligase dengan
    ziede 3-0
    Setelah Vena bebas,
    selanjutnya mencari
    arteri. Berikan
    operator mosquito
    dan pinset anatomi.
    Setelah terlihat
    arteri, berikan klem
    90 dan Tegel arteri
    dengan surgical loop
    merah
    Klem vena bagian
    distal persiapan
    untuk dipotong
    berikan mosquito
    klem untuk
    menjepit vena
    bagian distal
    Potong vena
    dengan
    menggunakan
    mess 11 dan
    distal vena yang
    terpotong diligasi
    menggunakan
    ziede 3-0 /
    mersilk 3-0 jarum
    round
    Berikan spuit 10cc
    dengan abocath no
    18/20 untuk
    Flushing vena
    dengan heparin
    1:100 bertujuan
    untuk dilatasi vena
    Vena dibulldog dan menggunakan
    gunting micro untuk membuat
    “sepatu” pada vena
    Klem arteri
    dengan statinski
    klem persiapan
    untuk arteriotomy
    dan anastomose
    Arteriotomy
    dengan mess
    11 perlebar
    dengan gunting
    micro
    Anastomose
    menggunakan
    benang
    nonabsorbable
    monofilament 7-
    0 dobel jarum
    Simpul akan
    dilakukan
    operator, basahi
    tangan operator
    sebelum
    menyimpul
    Evaluasi
    anastomose,
    pulasasi / thrill +,
    tidak ada
    bocor,vena
    mengembang.
    jahit kulit dengan
    monofilament
    absorbable 4-0
    Perawatan pasca bedah
    1. Pasien rawat jalan
    2. AV shunt tidak boleh ditensi, diambil
    darah, iv line, siku di tekuk n buat angkat
    beban
    3. Ketika pasien kontrol cek thril dan tanda
    klinis vaskularisasi
    Rule of Six
    AV Shunt

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