fLEBOTOMI

RINGKASAN BUKU AJAR FLEBOTOMI

RINGKASAN BUKU AJAR FLEBOTOMI

BAGIAN PATOLOGI KLINIK FAKULTAS KEDOKTERAN

BAGIAN PATOLOGI KLINIK FAKULTAS KEDOKTERAN

UNIVERSITAS SEBELAS MARET 2012

UNIVERSITAS SEBELAS MARET 2012

OLEH :

OLEH :

Dr. Elisa!"# L!$i%a Sari S!"ia%i%&r'(

Dr. Elisa!"# L!$i%a Sari S!"ia%i%&r'(

P!(i(i%& :

P!(i(i%& :

DR. )r. N*+(a% S',i- M.K!s- S.PK 

DR. )r. N*+(a% S',i- M.K!s- S.PK 

PENGERTIAN FLEBOTOMI

PENGERTIAN FLEBOTOMI

Fl!+"+(i a)ala# r+s!s !%&a(ila% )ara# )!%&a% "!/%i/ *a%& !%ar s!#i%&&a /+(+sisi 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  /ail!r. Asal /a"a )ari a#asa '%a%i *ai"' a%ali"%*a isa )i!r"a#a%/a%  (!lal'i $!%a- ar"!ri  /ail!r. Asal /a"a )ari a#asa '%a%i *ai"'  Phlebotomy

 Phlebotomy  )a  )ariri phleb phleb3!3!('('l'# )aral'# )ara# # $!%a $!%a  tomiatomia3(!%&iris4(!(+"+%& a)ala# i%sisi $!%a3(!%&iris4(!(+"+%& a)ala# i%sisi $!%a '%"

'%"'/ '/ (!%(!%&a(&a(il )ara#- 5)a#'lil )ara#- 5)a#'l'6:'6: venasectie.venasectie. T'7T'7'a% 'a% 8l!+"8l!+"+(i +(i a)ala# '%"'/ a)ala# '%"'/ (!%&#i%(!%&#i%)ari)ari /!sala#a% saa" !%&a(ila% )ara# *a%& )aa" (!(!%&ar'#i !(!ri/saa%. Fl!+"+(is a)ala# /!sala#a% saa" !%&a(ila% )ara# *a%& )aa" (!(!%&ar'#i !(!ri/saa%. Fl!+"+(is a)ala# s!s!+ra%& *a%& (!la/'/a% 8l!+"+(i.

s!s!+ra%& *a%& (!la/'/a% 8l!+"+(i. L!&al As!/ Fl!+"+(i

L!&al As!/ Fl!+"+(i S!+

S!+rara%& %& 8l8l!+!+"+"+(i(is s )i )i lala  a"a"a' a' RS RS 55!r!ra9a9a"a"4+4+rara%& %& *a*a%& %& )i)ilala"i"i# # /#/#'s's's's6 6 (!(!(('%*'%*aiai /!(a(

/!(a('a%  /!9!%a%&a% s!s'ai )!%&a% /+(!'a%  /!9!%a%&a% s!s'ai )!%&a% /+(!"!%si *a%& )i(i"!%si *a%& )i(ili/i *a%& )i!r+li/i *a%& )i!r+l!# l!# (!lal(!lal'i'i  !la"i#a%-

 !la"i#a%- 9+r/s#+- 9+r/s#+- !%)i)i/a% !%)i)i/a% )ari )ari i%s"i"'si i%s"i"'si *a%& *a%& !r9!%a%&. !r9!%a%&. I%i I%i #ar's #ar's )ila/'/a% )ila/'/a% /ar!%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% (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%.

(a/si(al !as )ari /!sala#a%. Sis"!( H'/'(

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 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!%&a7s!%&a7a a a"a' s!%&a7a (!%i('l/aa"a' s!%&a7a (!%i('l/a% % /!r'&i/!r'&ia% a% a)a asi!%6. Malra/"!a)a asi!%6. Malra/"!/ / a"a' /!lalaia%a"a' /!lalaia%  r+8!si+%al

 r+8!si+%al a)ala# a)ala# s'a"' s'a"' !la*a%a% !la*a%a% )i )i a9a# a9a# s"a%)ar- s"a%)ar- "i)a/ "i)a/ /+(!"!% /+(!"!% )a% )a% (!%&a/ia"/a%(!%&a/ia"/a% /!r'&ia% a&i asi!%.  #al *a%& #ar's )i'/"i/a% !%&&'&a" *ai"' : "'&as- /!lalaia%- /!r'&ia% a&i asi!%.  #al *a%& #ar's )i'/"i/a% !%&&'&a" *ai"' : "'&as- /!lalaia%- ,i)!ra-s!a a/ia".

s!a a/ia". I%8+rI%8+r( ( ,+%s!%" 5!rs!,+%s!%" 5!rs!"'7'a% (!)i/6 "'7'a% (!)i/6 a)alaa)ala# # !rs!!rs!"'7'a% asi!%  "'7'a% asi!%  /!l'ar/!l'ar&a &a s!,ars!,araa sa)ar '%"'/ (!%&i7i%/a% )i!ri/sa- )ila/'/a% "i%)a/a% (!)i/- )i+a"i +l!# "!%a&a /!s!#a"a% 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%

P!r!)aa% Dara# Ar"!ri- V!Dara# Ar"!ri- V!%a- %a- Kail!r Kail!r  Dar

Dara# a# ar"ar"!ri !ri a%*a%*a/ a/ +/s+/si&!i&!%- %- !r!r9ar9ar%a %a (!r(!ra# a# "!r"!ra%&- a%&- ilila a "!r"!r+"++"+%& %& )ar)ara# a# (!%*(!%*!(r!(r+"+" /!l'ar s!ira(a )!%*'"a% 7a%"'%&. Ka%)'%&a% &l'/+sa l!i# "i%&&i- s!l )ara# '"i#  (!ra#- /!l'ar s!ira(a )!%*'"a% 7a%"'%&. Ka%)'%&a% &l'/+sa l!i# "i%&&i- s!l )ara# '"i#  (!ra#- H-H" l!i# r!%)a# )ia%)i%&/a% )ara# $!%a. Biasa )ia/ai '%"'/ a%alisa &as )ara#

H" l!i# r!%)a# )ia%)i%&/a% )ara# $!%a. Biasa )ia/ai '%"'/ a%alisa &as )ara# Dara# $!%a 9ar%a l!i# "'a-

Dara# $!%a 9ar%a l!i# "'a- a&a/ '%&'- s!)i/i" +/si&!%a&a/ '%&'- s!)i/i" +/si&!%- ila - ila "!r+""!r+"+%& )ara# /!l'ar )!%&a%+%& )ara# /!l'ar )!%&a% al

alirira% a% *a*a%& %& rara"a"a. . L+L+/a/asi si !!%&a%&a((ilila% a% )a)arara# # !!rr!%!%&ar&ar'# '# aa)a )a /+(/+(+s+sisisi i )a)arara# # $!%$!%a.a. M!%&a%)'%& H l!i# r!%)a#. Biasa !(!ri/saa% la+ra"+ri'( (!%&&'%a/a% )ara# $!%a.

M!%&a%)'%& H l!i# r!%)a#. Biasa !(!ri/saa% la+ra"+ri'( (!%&&'%a/a% )ara# $!%a.

Dara# /ail!r "!r's !r'a# s's'%a%  9ar%a /ar!%a !r"'/ara% &as- !r)ara#a% /ail!r  Dara# /ail!r "!r's !r'a# s's'%a%  9ar%a /ar!%a !r"'/ara% &as- !r)ara#a% /ail!r  )i/

)i/!%al !%al )ar)ari i (!%(!%&al&alir%*ir%*a a )ar)ara# a# !r!rla#la#a% a% /! /! !r!r('/('/aa%aa%. . Ka)aKa)ar r &l'&l'/+s/+sa a l!l!i# i# "i%"i%&&i&&i- - /a)/a)ar ar   +"asi'(-

 +"asi'(- /alsi'(- /alsi'(- "+"al "+"al r+"!i% r+"!i% l!i# l!i# r!%)a#. r!%)a#. L!'/+si" L!'/+si" )a% )a% Lar&! Lar&! L!',+*"! L!',+*"! Ra"i+ Ra"i+ 5LLR6 5LLR6 l!i#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)aa"  as+/a% sara8- ali%& s!)i/i" rasa %*!ri  /!('%&/i%a% (!(ar%*a.Pili#a% /!)'a : $. ,!#ali,a

5 !sar "ai /'ra%& "!rli#a"- l!i# sa/i" )i"'s'/ )ia%)i%& $. (!)ia%a ,'i"al. Pili#a% /!"i&a : $.  asili,a 5(')a# )iraa- )!/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- "ai !%'s'/a% (!%i('l/a% rasa % *!ri- $!%a (')a# (!%&&'l'%&  s'li" )aa" )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)aa"- l!"a/%*a s'!r8isial- (!(ili/i /+la"!ral *a%& ai/- )aa" )!%&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%& )aa" "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%& )aa" "!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 : sara8-ar"!ri- $!%a- li(8a"i/ 5#a"i3#a"i6

ANTIKOAGULAN

Dia&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!sii"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!ra%)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 )aa"

)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 8iri% s"ail.

H!ari% )aa" (!%*!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/*.

Daa" (!%&'a a)a s'#' /a(ar a"a' =>ᵒ; a)a i%,'a"+r a"a' 9a"!ra"#. 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"- (!%&#iisi 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(!.

Daa" )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#+sa" D!"r+s!6  ;PDA1 5;i"ra" P#+sa" 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 : !rsiaa% asi!% s!!l'( !%&a(ila% !%&a (ila% s!si(!%-"ra%s+r" s!si(!%- !%a%&a%a%  !%*i(a%a% s!si(!%.

• P!rsiaa% 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#aa" 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- 'asa-s"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- Asar"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%- lii)- 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!rsiaa% !%&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  )aa" )i"'"' raa"

;. 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# /ail!r 5 '7'%& 7ari "!%&a#47ari (a%is a&ia% "!i a"a' )a!ra# "'(i" 14= a&ia% "!i "!laa/ /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'# "!rai  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 :

&i!ua'a 1 B+"+l /'l"'r )ara# 59ar%a

/'%i%& &aris #i"a(6

Br+"# (i"'r! M!%7a&a $iaili"as (i/r++r&a%is(! Mi/r+i+l+&i-/'l"'r a!r+-a%a!r+- 7a('r  2 Ta'%& %+% a)i/"i8 

= Ta'%& /+a&'lasi 5"'"' ir' "!ra%&6

S+)i'( si"ra"

M!%&i/a" /alsi'( T!s /+a&'lasi 5PT4aPTT6  Kl+" a/"i8a"+r 5"'"' (!ra#6 Kl+" a/"i8a"+r  Dara# !/' )is!%"ri8's! '%"'/  !(!ri/saa% s!r'( Ki(ia- s!r+l+&i-i('%+l+&i- ,r+ss (a",#

< S+)i'( #!ari% 5"'"' #i7a' "'a6 S+)i'( #!ari% a"a' li"#i'( #!ari% M!%+%a/"i8/a% "#r+(i% )a% "#r+(+las"i% U%"'/ /a)ar li"#i'( (!%&&'%a/a% s+)i'( #!ari%-'%"'/ /a)ar a((+%i'( (!%&&'%a/a% s+)i'( a"a' li"#i'( #!ari%  EDTA 5"'"' '%&'6 EDTA M!%&/#!lasi /alsi'(

H!(a"+l+&i- a%/ )ara# 5,r+ss (a",#6

> Ta'%& )ara# 5"'"' /'%i%&  ',a"6

D!"r+s! asa( si"ra"

I%a/"i8asi /+(l!(!% T!s DNA- HLA-"!s a"!r%i"as

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%& )aa" )i"'"' raa"  (')a# )ia9a

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"aili"as s!si(!%- 9a)a# s!si(!%.

Ca/"' !%*i(a%a% sa(!l

Jei+ pe,e$i'+aa #a'tu te,pat

Ki(ia /li%i/ Mi%&&' I R!8ri&!ra"+r  

I('%+l+&i Mi%&&' I R!8ri&!ra"+r  

#!(a"+l+&i Ja( 2 S'#' /a(ar  

K+a&'lasi Hari I R!8ri&!ra"+r  

T+/si/+l+&i Mi%&&'  R!8ri&!ra"+r  

Bl++) &r+'i%& Mi%&&' I 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' !rari%&

. Sia/a% ala" : 7ar'(- #+l)!r- "a'%&- sar'%& "a%&a%- "+r%i'!"- /aas al/+#+l- /aas4/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 )ia9a# "!(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# "!rasa%&.

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% /aas s"!ril- "ari/ 7ar'(- "!/a% /aas4 /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/3ali/ !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!sira"+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!%3asi!% &a%&&'a% !r%a8asa%  !ra" *a%& a/'"

). P!%&'/'ra% H )ara#- "!/a%a% ar"ial ;O2O2 (!(!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/ "!raa%*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%& (!%)aa" "!rai a%"i/+a&'la% 5&a%&&'a% /+a&'lasi6

8. Bypass grafting  T!s All!%

1. Palasi )!%*'" 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 "!laa/ "a%&a% a/a% "a(a/ ',a"

<. L!as/a% "!/a%a% a)a a.'l%aris

. Pa)a /+%)isi %+r(al "!laa/ "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 "!laa/ "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'!"

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  )aa" "!rli#a" 7!las.

2. L!"a//a% &'l'%&a% #a%)'/ )ia9a# !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 /+(+%!% <. Palasi '%"'/ (!%,ari r+,!ss's s"*l+i)!'s +s ra)i's

. Palasi )a!ra# 8l!+r "!%)+% ,ari 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 ,ari ra)ialis . Palasi )!%*'" %a)i  "!%"'/a% "i"i/ i('ls (a/si('(

. Pa)a /as's a.ra)ialis *a%& s'li" )ialasi 5(is.!)!(a  $as+sas(!6 )i&'%a/a% USG )+l!r

10. Lal'/a% a%as"!si l+/al "'%&&' =030 )!"i/

11. Ar"!ri *a%& a/a% )i"'s'/ )is"!ril/a% )!%&a% al/+#+l >0? )ii/'"i )!%&a% *+)i'(-&'%a/a% '/.1320 G- "'s'/a% 7ar'( )!%&a% l'a%& (!%&#a)a /! alira% )ara#-/!(iri%&a% =03< 5a.ra)ialis6- 0 5a.8!(+ralis6ᵒ

12. P'lsasi )ara# /! )ala( s*ri%&! (!%'%7'//a% )ara# )ari ar"!ri- iar/a% "!risi s!%)iri s+%"a%4asi8- ila ')ara "'r'" "!rasirasi (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 )ia9a# /'li"  'la%&i r+s!)'r.

1. S!"!la# s*ri%&! "!risi )ara#- ,a'" 7ar'(- "!/a% )!%&a% /asa4 /aas /!ri%& s"!ril (i%i(al 2 (!%i" 5 )ia%7'r/a% < (!%i"6 lal' )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% raa  'ls! ar"!ri a)a )a!ra# 8+ssa a%"!,'i"al- !%'s'/a% )!%&a% s')'" <ᵒ

P'%&si a.8!(+ralis

• Raa a.8!(+ralis "!a" )ia9a# "i"i/ "!%&a# li&a(!% i%&'i%al

• Mas'//a% 7ar'( )!%&a% s')'" 0 /! ara# 'lsasi ar"!ri '%"'/ s!/ali !%&a(ila% )ara#ᵒ ar"!ri. U%"'/ !%!(a"a% /a"!"!r- 7ar'( )i(as'//a% )!%&a% s')'" < (!%&#a)a /! a"as.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 23=1 (E4l  – Bas! !/s!s %+r(al 32- s4) 2-=

 – Sa"'rasi O2 l!i# )ari 0? K+(li/asi 8l!+"+(i ar"!ri

•  N*!ri • Eis+)! $as+$a&al • A%!'ris(a a.ra)ialis • P!r)ara#a% • I%8!/si • Sas(! 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- )aa" )ia/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% :

• 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'(

 – P!rsiaa% %!+%a"'s  +ra%& "'a

• 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!rsiaa% !"'&as

• LOKASI PENGAMBILAN DARAH KAPILER 

)o&itio -ee P$i/' Fi!e$ P$i/'  

A&! Bir"# "+ a+'"  (+%"#s O$!r  (+%"#s C!i&#" Fr+( =310 /&- ar+i(a"!l* Gr!a"!r "#a% 10 /& Pla,!(!%" +8 la%,!" O% "#! (!)ial +r la"!ral

 la%"ar 

O% si)! +8 "#! all +8 "#!

s'r8a,! 8i%&!r !r!%)i,'lar "+ "#! li%!s +8 "#! 8i%&!rri%" R!,+(!)!) 8i%&!r N+" ali,al! 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$i/' 5a)ala# !%&a(ila% )ara# a)a sa(!l )i "'(i" /a/i a&ia% la"!ral a"a' (!)ial63r!/+(!%)asi CHO- !r#a"i/a% /!)ala(a% "'s'/a% "i)a/ +l!# l!i# )ari 2- (( '%"'/ a*i r!(a"'r )a% la%,!" 0-< (( /!)ala(a%%*a /ar!%a )a!ra# "'(i" "!r)aa" %!r$'s la%"aris  "'la%& /al/a%!'s 53isa (!%i('l/a% /!r'sa/a% %!r$'s 

+s"!+(i!li"is6 • ANALITIK 

• T's'/a% )a!ra# /'li" :

• Pili# l+/asi *a%& "!a" 5a%"!,'i"i- )+rs'( !)is- $!%a /!ala6

• 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% /aas 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<ᵒ (!%i" '%"'/ (!%i%&/a"/a% alira% )ara#

• D!si%8!/si la"!ral la%"ar !)is- /!ri%&/a% )!%&a% /aas • T's'/ )!%&a% la%,!" %!9 +r%- "i)a/ +l!# 2-((

• Dara# !r"a(a /!l'ar )i'a%&- !rsi#/a% )!%&a% /aas /!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 • Raa 'lsasi $!%a

• T!(a"/a% /ar!" &!la%& )i a&ia% a"as /!ala 7i/a s'li" (!raa /!ala • Pasa%& 7ar'( s'%"i/ )!%&a% l!('"  asirasi !rla#a% '%"'/ (!%,!&a#

#!(+lisis )ara# a"a' +/l'si )i%)i%& $!%a.

• L!"a//a% /aas s"!ril lal' s!&!ra l!as/a% 7ar'(.

• T!/a% /aas !!raa 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- as!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#aa"- i)!%"i8i/asi 7!las- 7!las/a% "!/%i/ *a%& a/a% )ila/'/a% )!%&a% /a"a3/a"a *a%& )i(!%&!r"i- /!"!rlia"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/ 5a/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)ia%&/' i'6 )a% #+ri+%"al 5!rari%&6

• M!%&'ra%&i %*!ri

 – 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/

• M!%,!&a# !%'lara% !%*a/i"

 – Pa)a a%a/ )i r'a%& is+lasi '"'# ala" r+"!/si )iri '%"'/ (!%,!&a# !%'lara%

 !%*a/i"

 – Casa)a a)a a%a/ )!%&a% al!r&i /ar!"- la"! 5si%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+,aillar* s/i% '%,"'r!

S/i%'%,"'r! a)ala# r+s!s !%&a(ila% sa(!l )ara# (!lal'i "'s'/a% /'li" '%"'/

(!%)aa"/a% )ara# /ail!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,ailar* (!"#+)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" "!rai/ )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)aa" !('l'# )ara#- sara8  )!/a" "'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- "!raa )i%&i%- "!raa )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! )iili# a)a %!+%a"'s /ar!%a rasa sa/i" s!)i/i"- )ia%)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)aa"

 !%'('/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 5ili#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%& "!rasa%& "!rai IV li%!

P!%&a(ila% )ara# /ail!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% l'/a a/ar4ar'" a)a "!(a" !%&a(ila% )ara# $!%a

 Pasi!% *a%& sa%&a" &!('/

 Pasi!% *a%& (!%)aa" "!rai IV a)a /!)'a "a%&a%%*a

 Pasi!% *a%& (!(ili/i /+(li/asi s!ri's a/ia" $!%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# /ail!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' /ail!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' /ail!r )ila/'/a% /ar!%a !%iisa%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 !%&!,aa%- !%,i'(a%- !rasa3(al%'"risi • L!(a#%*a +"+"3,!%)!r'%& (!%7a"'#/a% s!s'a"'

• P!%'r'%a% )a*a i%&a"3l'a /aa% "!ra/#ir (a/a% • Jari%&a% s'/'"a%  !i"!l (!%7a)i l!i# "iis • 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 '%"'/ )ia9a

• P+sisi %*a(a% 5!rsa%)ar4ari%&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)aa" )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%4r+,ai% /ri( 5EMLA6

 – EMLA : E'"!,"i, Mi"'r! +8 L+,al A%as"!"i,s6 : &a'%&a% li)+,ai% 2-<?   r+,ai% 2-< ?

 – K!l!i#a% )a% /!/'ra%&a% EMLA

'eebi0a 'e'u$a!a

A(a% )i&'%a/a% a)a a%a/3a%a/ E8!/ a%as"!si ('%,'l s!"!la#  1 7a( )iali/asi

Pr+s!s (')a# M!%&&'%a/a% !%'"'

EMLA )aa" (!%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

Keebi0a Ke'u$a!a

A%as"!si *a%& !8!/"i8 Har's (!%&&'%a/a% !%'"'

Ca/"' ali/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",# 5SNERA6- ri%si (!l!as/a% rasa a%as

 a)a /'li" s!#i%&&a (!%i%&/a"/a% !%*!raa% +a". M!%&a%)'%& > 0(& li)+,ai%  "!"ra,ai% >0 (&

• K!l!i#a%  /!/'ra%&a% a%as"!si a",#

'eebi0a 'e'u$a!a

;ara !(a/aia% (')a# M!%i('l/a% rasa a%as s!!r"i "!ra/ar A(a%  !8!/"i8 Ti)a/ )ia%7'r/a% !%&&'%aa% ('l"il! s*%!ra

 a",#!s Daa" )i&'%a/a% a)a a%a/3a%a/- +ra%&

)!9asa  la%sia

B!l'( a)a !8!/ sis"!(i/

• A%as"!si Sra* : 8l'+ri3M!"a%a Sra* 5Va+,+ala%" sra*6- "i)a/ (')a#

"!ra/ar-(!%*!a/a% !%)i%&i%a% s!(!%"ara !r('/aa% /'li"- )ia/ai )!%&a% (!%&&'%a/a%  +la /aas- iar/a% ,aira% (!%&'a )a% )i'sa )!%&a% al/+#+l

EMLA K$i, AMETOP !e SYNERA Pat/0 apo/oaat +p$a%

Ca/"' *a%& )i'"'#/a%

M!%i" 0 M!%i" =03< M!%i" 20 D!"i/ 0

D'rasi 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 "!ra/ar Rasa "!ra/ar  a)a asi!% 'sia

PENYULIT DAN KOMPLIKASI

TEKNIK SULIT PADA FLEBOTOMI

T!r7a)i a)a asi!% l'/a a/ar- asi!% *a%& "!rasa%& &is- !)!(a- #!(a"+(a- asi!%  +s" (as"!/"+(i- asi!% )ialisis- asi!% *a%& s!)a%& (!%!ri(a "ra%s8'si  asi!% *a%&

"!rasa%& i%8's. B!!raa /+%)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/ )')'/ )ia%&/'- "!(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/ !rari%& (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!(aa% s!#i%&&a /'li" (')a# l'/a )a% ra'# )a% /+las !('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!"!ra"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!%

PEMILIHAN ALAT

M!"+)! "!rai/ '%"'/ (!%)aa"/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' /ail!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% )aa" (!%&'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/ia" !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/ia" 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- aa/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

• 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