Fluid Management & Blood Component Therapy
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FLUID MANAGEMENT & BLOOD COMPONENT
THERAPY
Disusun oleh:Joko SantosoNur Aprillia R.
Dewi Guntar R.
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Evaluasi Volume Intravaskular Patient History intake oral, muntah atau
diare persisten, Pemeriksaan Fisik Pemeriksaan Lab hct, pH darah arteri,
urinary specific gravity, osmolalitas, konsenterasi Na+ atau Cl- urin, Konsenterasi Na+ serum, rasio ureum:kreatinin
Pengukuran Hemodinamik CVP, PAOP, esophageal Doppler, transesophageal echocardiograph
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Terapi IV Crystalloid Solution Colloid Solution
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Crystalloid Solution Resusitasi cairan awal pada pasien dg syok
hemoragik dan septik, pasien luka bakar, pasien dg cedera kepala, dan pada pasien yg menjalani plasmapheresis dan reseksi hepar.
Pemilihannya berdasarkan jenis cairan yg hilang. Bila yg hilang hanya cairan diganti dg
hypotonic solution maintenance-type solution Bila yg hilang cairan dan elektrolit diganti dg
isotonic solution replacement-type solution. Cairan dg glukosa tujuannnya untuk menjaga
tonisitas cairan atau mencegah ketosis dan hipoglikemia.
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Cont’ Kehilangan cairan intraoperatif isotonik
replacement-type solution paling sering dipakai RL.
RL sedikit hipotonik memiliki efek yg sangat kecil terhadap komposisi cairan ekstrasel dan merupakan cairan yg paling fisiologis bila diberikan dalam jumlah yg banyak.
NS (NaCl 0,9%) bila diberikan dlm jumlah yg besar dapat menyebabkan asidosis hiperkloremik karena mengandung Na+ dan Cl- yg tinggi biasanya dipakai pada pasien dg alkalosis metabolik dan sebelum transfusi PRC.
D5W digunakan untuk penggantian air murni dan maintenance cairan pada pasien dg restriksi Na+.
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Colloid SolutionIndikasi penggunaan koloid: Resusitasi cairan pada pasien dg defisit
cairan intravaskular berat (pada syok hemoragik).
Resusitasi cairan pada pasien dg hipoalbuminemia berat atau kondisi dengan kehilangan protein dlm jumlah besar (luka bakar).
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Terapi Cairan Perioperatif Kebutuhan maintenance normal Defisit cairan yang masih berlanjut Kehilangan cairan dari luka bedah
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Kebutuhan Maintenance Normal
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Preexisting Deficits Defisit akibat puasa sebelum op Abnormal fluid loss perdarahan,
muntah, diuresis dan diare pre-op Occult losses ascites ↑ IWL hiperventilasi, demam dan
keringat.
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Surgical Fluid Losses Blood Losses Other Fluid Losses Evaporasi dan
redistribusi interal cairan tubuh
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Penggantian Kehilangan Darah Hitung EBV Hitung estimated RBCV pada hct pre-op Hitung estimated RBCV pada hct 30%
asumsikan EBV normal Hitung RBCV loss = RBCV preop – RBCV
30% Hitung blood loss = RBCV loss/hct preop
Transfusi dianjurkan setelah hct < 24% (Hb < 8 mg %).
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1 unit PRC meningkatkan Hb 1 g% dan hct 2-3%
10 cc/kg RBC meningkatkan Hb 3 g% dan hct 10%
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Redistribution and Evaporative Surgical Fluid Loss
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TransfusiGolongan darah ABO system Rh system Other RBC antigen system
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Tes Kecocokan ABO –Rh testing Antibody screen Crossmatch
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Intraoperative Transfusion Packed Red Cell (PRC) Fresh Frozen Plasma (FFP) Platelets Granulocyte Transfusion Procoagulant Transfusion
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Komplikasi Transfusi Komplikasi imun Reaksi hemolitik reaksi hemolitik akut,
reaksi hemolitik tipe lambat Reaksi imun non hemolitik reaksi
demam, reaksi urtikaria, reaksi anafilaktik, transfusion-related acute lung injury, purpura post-tranfusi
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Komplikasi Infeksi Infeksi virus Hepatitis B, C, AIDS, CMV,
Epstein-Barr Virus Infeksi parasit malaria, toksoplasmosis,
Chagas disease Infeksi bakteri gram +
(Staphylococcus), gram – (Yersinia dan Citrobacter) yg jarang: syphilis, brucellosis, salmonelosis, yersiniosis, rickettsioses
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Transfusi Darah MasifDefinisi: kebutuhan transfusi 1-2 x total EBV kira2 10-20 unit.
Pada transfusi darah masif dpt terjadi: Koagulopati dilutional thrombocytopenia Toksisitas sitrat sitrat dari produk darah terikat dg kalsium hipokalsemia depresi jantung
Hipotermia Keseimbangan asam-basa asidosis Konsenterasi kalium serum hiperkalemia
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Manajemen Kehilangan Darah Alternatif Selama Operasi
Transfusi autolog darah diambil dari pasien 4-5 minggu sebelum op pada saat op ditransfusikan darahnya sendiri.
Blood salvage & reinfusion darah yang keluar intraoperative diaspirasi ke dlm sebuah reservoir dan dicampur dg heparin di reinfus ke pasien.
Normovolemic hemodilution sebelum op, 1-2 unit darah diambil dari pasien dan dan digantikan dg kristaloid atau koloid (hct pasien 21-25%) setelah pasien kehilangan darah, darah tsb diberikan ke pasien.
Donor-directed transfusion donor langsung dari keluarga pasien.
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