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All Journal Jurnal Anestesiologi Indonesia Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Majalah Anestesia dan Critical Care Jurnal Plastik Rekonstruksi Indonesian Journal of Anesthesiology and Reanimation (IJAR) Bioscientia Medicina : Journal of Biomedicine and Translational Research Majalah Anestesia & Critical Care (MACC) Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Jurnal Komplikasi Anestesi
Sugiarto, Adhrie
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran Universitas Indonesia – RSUPN Nasional Dr. Cipto Mangunkusumo, Jakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Developing “do it yourself” Phantom for Teaching Seldinger Technique in Vascular Access Placement to General Practitioners Hafidz, Noor; Sedono, Rudyanto; Aditianingsih, Dita; Sugiarto, Adhrie; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 7 No. - (2023): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v7i-.201

Abstract

Establishing a vascular access is a crucial aspect in managing critically ill patients in the Intensive Care Unit (ICU). The skill in placing vascular access varies among healthcare professionals. Clinical experience and level of training among nurses, general practitioners, and intensivists are the determinants of skill in placing vascular access. Training to establish vascular access using the Seldinger technique needs practice using a vascular phantom or a cadaver. Commercially sold phantoms are difficult to get, and an alternative training phantom is needed. We built a simple “do-it-yourself” model of a vascular phantom using “easy-to-find” material that can be used to practice the Seldinger technique. We used a synthetic polyurethane sponge 16x16 cm in size as a base and a polyvinyl alcohol sheet of the same size. We used 22 F urinary catheters trimmed to 12 to represent blood vessels. The final product is a piece of the urinary catheter embedded in the sponge and then covered by polyvinyl alcohol to simulate the epidermis. The phantom can be used in training programs to improve the skill of general practitioners in placing advanced vascular access. 13 general practitioners were involved in this training, and 100% said that this phantom could simulate the experience. “Do-it-yourself” phantom for vascular access training can be used ro practice the Seldinger technique and can simulate the real experience.
The Dual Effect of Tolvaptan on Diuresis and Azotemia in a Case of Acute Kidney Injury with Furosemide Resistance After Coronary Artery Bypass Grafting: A Case Report Supriyadi, Eddo; Karseno Dibyosubroto, Iradewi; Sugiarto, Adhrie
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 9 No. - (2025): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v9i-.313

Abstract

Background: Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) affects up to 30% of patients, increasing morbidity and mortality. Increasing Furosemide dose, by blocking sodium, potassium, and chloride reabsorption, paradoxically increases urea reabsorption to maintain medullary osmolarity. This increased urea retention reduces Furosemide’s effectiveness and can elevate urea levels. Tolvaptan, a V2 receptor antagonist, indirectly inhibits Urea Transporter A1 (UT-A1), potentially opposing this effect. Case Presentation: A 67-year-old man post-CABG developed inadequate diuresis despite high-dose Furosemide (20 mg/hour). Post-extubation, he experienced worsening dyspnea, positive fluid balance, elevated Central Venous Pressure (CVP), and a sharp rise in creatinine (0.97 to 4.74 mg/dL). Dialysis was planned on Day 3 but deferred for observation after initiating Tolvaptan. Following Tolvaptan administration, diuresis improved, CVP decreased, and Creatinine fell to 2.11 mg/dL. The patient recovered without further events. Discussion: This case describes the potential use of Tolvaptan as an adjunct to Furosemide to improve diuresis and decrease urea reabsorption. Furosemide improves diuresis by blocking electrolyte reabsorption, but this effect is often counteracted by a compensatory increase in urea reabsorption to maintain peritubular tissue osmolarity, which lowers the overall potency of the diuretic. This water retention, coupled with increased sodium chloride in the tubule, triggers the macula densa and juxtaglomerular feedback, thus lowering GFR. Conclusion: Tolvaptan's potential to augment diuresis and improve urea removal is beneficial to reduce the need for dialysis. Further study is needed to confirm this theoretical application in other clinical settings.
Co-Authors Aditya Wardhana Agustina Haloho Alatas, Anas Aldy Heriwardito Amir S Madjid Amir S Madjid Anas Alatas Arifin Arifin Asri C. Adisasmita Dita Aditianingsih Dwiputra, Anggara Gilang Eko Setijanto Hafidz, Noor Haloho, Agustina Br Harijanto, Eddy Heni Pujiastuti Hunter Design Nainggolan Inge Permadhi Jefferson Hidayat Jefrey Tuhulele, Norman Rabker Karseno Dibyosubroto, Iradewi Madeline Marpaung Manggala, Sidharta Kusuma Mohamad Rachadian Ramadan Mufaza, Uyun Muhammad Husni Thamrin Nugraha, Taufiqo Peni Yulia Nastiti Perdana, Aries Purwoko Purwoko Putri, Regina Prima Rahmah, Herlina Ramlan, Andi Ade Wijaya Rosdiana, Prita Rudyanto Sedono Rudyanto Sedono, Rudyanto Septian Adi Permana Setiadi, Bakti Shendy Meike Sari Supriyadi, Eddo Tantri, Aida Thariqah Salamah Zahrina, Fadiah Zulkifli