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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute
Manggala, Sidharta Kusuma
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Health Professions Medicine & Pharmacology Neuroscience Public Health

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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 Economic Burden on Private Hospitals in Treating ICU Vs Non-ICU Patients: Investigating The Financial Gap Between Indonesian Case Base Groups (INA-CBG) Rates and Hospital Billing Halim, Ida Juita; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): 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.v8i-.241

Abstract

Objectives: Indonesia’s healthcare financing relies on a bundled payment system, the Indonesian Case Base Groups (INA-CBG) rates, whereas private hospitals calculate costs using Activity-Based Costing (ABC). This difference can lead to significant financial gaps, especially in ICU and non-ICU care. Methods: A random sample of 93 ICU and non-ICU patients from a private hospital in Bekasi, West Java, was analyzed. We compared the INA-CBG rates and hospital billing for ICU and non-ICU care by considering comorbidities, hospital length of stay (LOS), and mortality rates. Results: The average LOS was longer for ICU patients (6.78 days) than non-ICU (4.98 days). The ICU mortality rate was 20%, while non-ICU was 2.33%. Globally, ICU LOS averages 5-7 days, with a 30% mortality rate. INA-CBG covered only 41.89% of costs for non-ICU patients and 57.14% for ICU patients. Conclusion: This study demonstrates the significant financial strain created by the discrepancy between the INA-CBG claims and the actual costs particularly for private hospitals handling patients with high severity.
Plasmapheresis and Multidisciplinary Intensive Care Management for Guillain-Barré Syndrome with Prolonged Mechanical Ventilation: A Case Report Indrawan, Khadafi; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): 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.v8i-.249

Abstract

Guillain-Barré syndrome (GBS) is a rare, acute autoimmune peripheral neuropathy often triggered by infections. It leads to rapid-onset muscle weakness and, in severe cases, respiratory failure requiring mechanical ventilation. Plasmapheresis is recommended to reduce circulating autoantibodies that damage peripheral nerves. Guidelines suggest that early initiation of plasmapheresis may improve clinical outcomes, especially in patients with significant motor weakness. A 41-year-old female was referred to the emergency room with progressive ascending bilateral limb weakness, sensory deficits, and urinary incontinence. Symptoms emerged 26 days prior and treatments from previous hospitals were ineffective. Physical examination revealed cranial nerve involvement, proprioceptive disturbance, and reduced deep tendon reflexes. Laboratory tests showed leukocytosis, thrombocytosis, hypoalbuminemia, electrolyte imbalance, and elevated D-dimer. Cerebrospinal fluid analysis was normal. The patient was diagnosed with GBS, intubated by day six post-admission due to respiratory failure and tracheotomized by day eight. The patient was admitted to the intensive care unit. Plasmapheresis, initiated on day 17, improved motor strength after three sessions spaced over 10 days. However, delayed intervals between sessions and limited access potentially impeded the recovery process. Despite improvements, the patient remained ventilator-dependent and require multidisciplinary interventions. Inhalation therapy, enteral feeding, physical rehabilitation, and psychiatric interventions were administered. The family was informed of potential long-term ventilator dependency and home care preparation. This case underscores the importance of timely plasmapheresis and coordinated, multidisciplinary ICU management in severe GBS, encompassing neurological treatment, respiratory care, nutrition management, physical rehabilitation, and psychological support for the patient and their caregivers.
Co-Authors Asri C. Adisasmita Dita Aditianingsih Hafidz, Noor Halim, Ida Juita Khadafi Indrawan Rahmah, Herlina Rosdiana, Prita Rudyanto Sedono, Rudyanto Sugiarto, Adhrie Zahrina, Fadiah