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 radiat ...

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 perfor ...

, insertion of chest drains and central venous catheters, 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 eit ...

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 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, v ...

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 dis ...

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 deri ...

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 frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

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 tubing (material), 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 surgi ...

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 function ...

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 i ...

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 dise ...

, 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,

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

References

External links

Flash animation of the Seldinger technique
(FRCA.co.uk) * {{Vascular procedures Diagnostic cardiology Interventional radiology