Doctor Anestesi Explains The Importance Of Installing Safe And Proper Vascular Access

JAKARTA - One of the most important procedures in daily medical services is the installation of vascular access, both for infusion, administration of drugs, fluids, transfusions, and monitoring of critical patients.

However, not all patients have a blood vessel that is easy to find. This is where the expertise of an anesthetic and intensive doctor plays an important role in ensuring the safety and success of the procedure.

According to dr. Irvan Setiawan, Sp. AN., KIC, Doctor Anestesi and Intensist, often people understand that anesthesia is only limited to anestheticism.

"You know it's just an anesthetic, sleeping on patients, all kinds of things. For the installation of vascular access, it's usually our job to install access to the central veins," said dr. Irvan, when met in Bintaro Jaya, South Tangerang on Saturday, November 1, 2025.

dr. Irvan explained that the vascular access is divided into two types.

"We share the access to the vascular in peripheral and central access. The filter is downstream, either in the hands or lower arms. Meanwhile, central access means that the end of the catheter is in the mouth of the heart," he explained.

Access to the central veins is generally needed under several conditions, such as for the administration of drugs with very acidic pH or bases, giving high concentration liquids that have the potential to damage the tissue when given through peripheral blood vessels, as well as in critical conditions that require intensive hemodynamic monitoring.

dr. Irvan emphasized the risk of using peripheral infusion for certain drugs.

"Many medicines that are used in ordinary peripheral infusions can cause irritation. It can also become swollen, black, and must be amputated because the drug damages the surrounding tissue," he explained.

Not all patients have easy to find blood vessels. Groups of patients with Difficult Intravenous Access (DIVA) have the risk of repeated punctures, pain, and delays in therapy.

"We can score our veins. Whether the veins is visible or can only be felt, or we have to tie it up first and then appear. From there we can find out if this is easy or difficult," said dr. Irvan.

If it is difficult, health workers should not keep trying.

"If children or patients have difficulty installing IVs, don't try them again. We have to go directly to more advanced methods like ultrasound," he said.

According to him, the wrong stab is not a trivial thing.

"The venous blood clot is adjacent to the arteries. If it is stabbed in the arteries, it can continue to leak. If it gets nervely, it can get numb until it is paralyzed. If it is in the chest and has a pleura, the lungs can collapse and the patient is short of breath," he continued.

Therefore, the installation of central access must be carried out by medical personnel trained with the right technique.

Now the use of Ultrasonography (USG) is a real-time guide that increases the success of installing and reduces complications.

"With ultrasound, before we stab, we already know. So we don't need to try there, try here. Especially for children. It can traumatize," he explained.

The technique provides better results with a significant increase in the number of first stab successes, reduced the number of stabs required, as well as a reduced risk of bleeding and tissue injury.

dr. Irvan emphasized that this skill can be learned by doctors and nurses.

"The one who taught me 10 years ago was a nurse from America. So there, nurses are used to doing this with feelings. The important thing is to be trained," he said.

To support the improvement of clinical competence, a training titled Ultrasound-Guided Vascular Access Investigation was held on November 1, 2025 at Kedai Om George, Bintaro Jaya, South Tangerang.

The participants are health workers from various institutions. This training was initiated by dr. Irvan Setiawan with the vascular access education community via Instagram @vas.acc.

Training focuses on vein identification techniques with ultrasound, catheter selection, prevention of complications, to direct practice.

"The main goal is to reduce the number of failures to install vascular access, especially in DIVA patients so that services are faster and safer," he said.

Installation of vascular access is not just a technique of stabbing blood vessels, but a crucial part of patient safety.

With a proof-based approach, ultrasound use, and continued competency training, patient pain can be reduced, complications can be prevented and the quality of health services increases significantly.