Seldinger technique

The Seldinger technique is a medical procedure to obtain safe access to blood vessels and other hollow organs. It is named after Dr. Sven-Ivar Seldinger (1921-1998), a Swedish radiologist from Mora, Dalarna County, who introduced the procedure in 1953.^[1]

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Description

The desired vessel or cavity is punctured with a sharp hollow needle called a trocar, with ultrasound guidance if necessary. A round-tipped guidewire is then advanced through the lumen of the trocar, and the trocar is withdrawn. A "sheath" or blunt cannula can now be passed over the guidewire into the cavity or vessel. Alternatively, drainage tubes are passed over the guidewire (as in chest drains or nephrostomies). After passing a sheath of tube, the guidewire is withdrawn.^[1]

If a sheath is used, it can be used to introduce catheters or other devices to perform endoluminal (inside the hollow organ) procedures, such as angioplasty. Fluoroscopy may be used to confirm the position of the catheter and to manoeuvre it to the desired location. Injection of radiocontrast may be used to visualise organs. Interventional procedures, such as thermoablation, angioplasty, embolisation or biopsy, may be performed.

Upon completion of the desired procedure, the sheath is withdrawn. In certain settings, a sealing device may be used to close the hole made by the procedure.

Uses

The Seldinger technique is used for angiography, insertion of chest drains and central venous catheters, insertion of PEG tubes using the push technique, insertion of the leads for a artificial pacemaker or implantable cardioverter-defibrillator, and numerous other interventional medical procedures.

Complications

The initial puncture is with a sharp instrument, and this may lead to hemorrhage or perforation of the organ in question. Infection is a possible complication, and hence asepsis is practiced during most Seldinger procedures.

Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable complication.^[2]

History and impact

Prior to the description of the Seldinger technique, sharp trocars were used to create lumens through which devices could be passed. This had a high rate of complications.^[3] However, with the introduction of the Seldinger technique, angiography became a relatively risk-free procedure, and the field of interventional radiology blossomed.

Building on the work of Seldinger, Charles Dotter and Andreas Gruentzig developed angioplasty.

References

1. ^ ^{a b} Seldinger SI (1953). "Catheter replacement of the needle in percutaneous arteriography; a new technique". Acta radiologica 39 (5): 368–76. PMID 13057644.
2. ^ Schummer W, Schummer C, Gaser E, Bartunek R (2002). "Loss of the guide wire: mishap or blunder?". British journal of anaesthesia 88 (1): 144–6. PMID 11881872.
3. ^ Higgs ZC, Macafee DA, Braithwaite BD, Maxwell-Armstrong CA (2005). "The Seldinger technique: 50 years on". Lancet 366 (9494): 1407–9. doi:10.1016/S0140-6736(05)66878-X. PMID 16226619.