“Optimizing The Quality of Life Children Under SDGs” Sustainable Development Goals
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and radial artery puncture repetition on the action of transradial cardiac catheterization can increase damage or injury to the blood vessels, causing bleeding and increase the incidence
of hematoma.
Make sure the proper location before stabbing at the radial artery, use the touch pulsasinya clear and precise needle punctures so cultivated once successful, because in
case of failure will increase the risk of hematoma.
f. TR Band and Genesis Hematoma
Patients who underwent cardiac catheterization with the use of TR Band with air pressure ofl ess than 13 cc may affect the incidence of hematoma p value = 0.00, with the infl uence
of 13.9 times the hematoma. There is no type of effective compression tool that can provide the proper pressure and does not cause complications hematoma
19
. The emphasis of the radial artery using TR Band with pressure 13 cc is not always
safe because of a complaint against vascularization to the area distal from the radial artery as well as the pain that needs to be reduced pressure of 13 cc, with pressure reduction will
lead to injury of blood vessels have not been returned or hemoestasis process has not been formed so bleeding and hematoma occurred
15
. TR pressure reduction Band performed before his time with the consideration in the
event of disruption of blood fl ow to distal and pain resulting hemodynamic disturbances are likely due to the use of TR Band. Pengurakan pressure TR Band performed but is likely to
occur hematomas so long as the reduction is to be monitored the occurrence of hematoma and circulation to the area distal to the ulnar artery pulsation felt so comfort of patients remain
unnoticed.
g. Body mass index and incidence of hematoma
Patients who underwent cardiac catheterization with normal Body Mass Index and not normal no effect on the incidence of hematoma p value = 0.661 greater than 0.05, with much
infl uence the occurrence of hematoma 0 times. Based on the analysis by the Chi-Square data showed that there were no differences in the incidence of hematoma proportion with
body mass index p value = 0.661; 0.5, with OR = 0 means that patients with a BMI over with normal BMI did not infl uence the occurrence of hematoma.
Body mass index indicates overweight where there will be a buildup of thick muscle mass which includes the area of the femoral and radial diradialis bit. The thickness of the muscle in
the insertion area will affect the conduct arterial insertion in the cardiac catheterization action that will have diffi culty in fi nding areas that will be in cannulation artery and the manipulation
of the catheter during catheterization jantung action
20
. The thickness of the muscle in the femoral area is thicker than in the radial artery area, so that the diffi culties at the femoral
artery access is more diffi cult than the radial artery that obesity will affect hematoma in transfemoral compared transradial cardiac catheterization.
Based on the test results of the bivariate analysis with chi square test, there are fi ve variables: the type of drug administration, the size of the sheath, the value of blood pressure,
puncture and TR Band frequency, the effect on the incidence of hematoma, while variables body mass index showed no effect on the incidence of hematoma.
The variables that most infl uence on the incidence of hematoma with OR greatest value is variable sheath size is 31.6, while the smallest infl uence on the incidence of hematoma
is the frequency factor puncture with an OR of 4.4.
106 PROCEEDING BOOK
The 2
nd
International Conference on Health Science 2015
2. Multivariate Analysis
Based on the results of the bivariate analysis with chi-square of five variables administration of medication types, sheath size, systolic blood pressure values, frequency
puncture and TR Band obtained pvalue 0.05 means that fi ve variables can continue to do the analysis for the logistic regression model determine the most dominant factor to the
incidence of hematoma of these fi ve factors.
Based on the results of the results of multivariate logistic regression analysis of the fi ve variables signifi cantly infl uence the incidence of hematoma, these fi ve variables are
the number of drug types, sheath size, blood pressure, puncture frequency, size TR Brand. Logistic regression analysis results of fi ve variables that affect the occurrence of hematoma
in patients undergoing transradial Cardiac Catheterization action at Hospital Dr. Sardjito is the amount of anticoagulant drug administration.
This means that after fi ve factors that infl uence the incidence of hematoma tested simultaneously then showed that patients given anticoagulant drugs two or more kinds
19
.115 times have infl uence on the incidence of hematoma in patients undergoing transradial cardiac
catheterization in Hospital Dr. Sardjito compared to other variables. While the smallest effect on multivariate phase is the frequency puncture.
During cardiac catheterization action has been correlated unfractionated heparin, the dose and increased partial thromboplastin time to improve vaskular
17
complications. Anticoagulation drugs used during cardiac catheterization action is unfractionated heparin
UFH
21
. Heparin is aprimary anticoagulant where the effect is to disable thrombin and inhibits
factor X via antithrombin, by inactivating thrombin, the heparin not only prevents the formation of fi brin but also inhibits the activation of thrombin-induced platelet and factors V and VIII,
UFH is thrombin inhibitor indirectly, and requires the presence of cofactor antithrombin to be effective. Heparin is a specifi c action and nonlinear, and each patient responds differently
to heparin doses
13
. Active Heparin sometimes free to do more work on antithrombin. Heparin worksare in
the same lane at work clotting factors XIIa, Xa, and IXa serine protease others. Binding of heparin on coagulation factors and antithrombin both very important in enhancing antithrombin.
Work heparin on factor Xa are also mediated by increased affi nity of antithrombin for clotting factors but did not bind factor Xa heparin. Factor Xa inhibiting improvement compared with
lower levels of heparin that has been measured to inhibit thrombin. Heparin reduces platelet agresasi secondary to the reduction in thrombin a potent cause of platelet aggregation. An
increase in lipases cause increased plasma free fatty acids.
UFH anticoagulation and antiplatelet group aims to improve Activated Cloting Time ACT and Activated Thromboplastin Time APTT. Improved ACT and APTT is required
when the patient underwent cardiac catheterization to prevent blood clotting and thrombus occurrence, on the other hand with an increase in ACT may increase the risk of bleeding in
patients post cardiac catheterization
11
. Patients who underwent cardiac catheterization have already got the drug Aspilet or
clopidogrel or class of antiplatelet, this class of drugs prevents adhesion and aggregation of platelets by inhibiting a receptor on the membrane of platelets, preventing the interaction
of platelets or the interaction of platelets premises chemicals blood clotting another
14
. The impact of these drugs is going to increase bleeding and increase the risk of hematoma.
