![Seldinger Set](https://upload.wikimedia.org/wikipedia/commons/6/6e/Seldinger_Set.jpg)
The Seldinger technique, also known as Seldinger wire technique, is a
medical procedure
A medical procedure is a course of action intended to achieve a result in the delivery of healthcare.
A medical procedure with the intention of determining, measuring, or diagnosing a patient condition or parameter is also called a medical test. ...
to obtain safe access to
blood vessel
The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...
s and other hollow
organs. It is
named after Sven Ivar Seldinger (1921–1998), a
Swedish
Swedish or ' may refer to:
Anything from or related to Sweden, a country in Northern Europe. Or, specifically:
* Swedish language, a North Germanic language spoken primarily in Sweden and Finland
** Swedish alphabet, the official alphabet used by ...
radiologist
Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiatio ...
who introduced the procedure in 1953.
Uses
The Seldinger technique is used for
angiography
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performe ...
, insertion of
chest drain
A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a surgical drain that is inserted through the chest wall and into the pleural space or the mediastinum in order to remove clinically undesired substan ...
s and
central venous catheters
A central venous catheter (CVC), also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centra ...
, insertion of
PEG tubes using the push technique, insertion of the leads for an
artificial pacemaker
An artificial cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural cardiac pacemaker) or pacemaker is a medical device that generates electrical impulses delivered by electrodes to the chambers of the heart eith ...
or
implantable cardioverter-defibrillator
An implantable cardioverter-defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device implantable inside the body, able to perform defibrillation, and depending on the type, cardioversion and pacing of the ...
, and numerous other interventional medical procedures.
Complications
The initial puncture is with a sharp instrument, and this may lead to
hemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
or
perforation
A perforation is a small hole in a thin material or web. There is usually more than one perforation in an organized fashion, where all of the holes collectively are called a ''perforation''. The process of creating perforations is called perfor ...
of the organ in question.
Infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
is a possible complication, and hence
asepsis
Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deriv ...
is practiced during most Seldinger procedures.
Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable complication.
Description
The desired vessel or cavity is punctured with a sharp hollow needle, with
ultrasound
Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
guidance if necessary. A round-tipped guidewire is then advanced through the
lumen of the needle, and the needle is withdrawn. A sheath or blunt
cannula
A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...
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 or tube, the guidewire is withdrawn.
[
An introducer sheath can be used to introduce ]catheter
In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cath ...
s or other devices to perform endoluminal (inside the hollow organ) procedures, such as angioplasty
Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atheroscle ...
. Fluoroscopy
Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...
may be used to confirm the position of the catheter and to manoeuvre it to the desired location. Injection of radiocontrast
Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography (contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically io ...
may be used to visualize organs. Interventional procedures, such as thermoablation, angioplasty, embolisation or biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
, 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.
File:Catheter Schema 1 pose de l'aiguille.svg, Step 1
File:Catheter Schema 2 pose du fil.svg, Step 2
File:Catheter Schema 3 retrait de l'aiguille.svg, Step 3
File:Catheter Schema 4 entree et sortie du dilatateur.svg, Step 4
File:Catheter Schema 5 pose du catheter.svg, Step 5
File:Catheter Schema 6 catheter en place.svg, Step 6
A modified technique, known as the accelerated Seldinger technique, has also been described where the needle, guidewire, dilator, and sheath are inserted as one unit.
History
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. However, with the introduction of the Seldinger technique, angiography
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performe ...
became a relatively risk-free procedure, and the field of interventional radiology
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...
blossomed.
Building on the work of Seldinger, Charles Dotter
Charles Theodore Dotter (14 June 1920 – 15 February 1985) was a pioneering US vascular radiologist who is credited with developing interventional radiology. Dotter, with his trainee Dr Melvin P. Judkins, described angioplasty in 1964.
Dotte ...
and Andreas Gruentzig
Andreas Roland Grüntzig (25 June 1939 – 27 October 1985) was a German radiologist and cardiologist, with foundational interest, training and research in epidemiology and angiology. He is known for being the first to develop successful balloon a ...
developed angioplasty
Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atheroscle ...
.
References
External links
Flash animation of the Seldinger technique
(FRCA.co.uk)
*
{{Vascular procedures
Diagnostic cardiology
Interventional radiology