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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 The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits blood to circulate and transport nutrients (such as amino ...
s and other hollow
organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly cate ...
s. It is named after Dr.
Sven Ivar Seldinger Sven Ivar Seldinger (19 April 1921 – 21 February 1998), was a radiology, radiologist from Mora Municipality, Sweden. In 1953, he introduced the Seldinger technique to obtain safe access to blood vessels and other hollow organ (anatomy), organs. B ...
(1921–1998), a
Swedish Swedish or ' may refer to: * Anything from or related to Sweden, a country in Northern Europe * Swedish language, a North Germanic language spoken primarily in Sweden and Finland * Swedish alphabet, the official alphabet used by the Swedish langua ...

Swedish
radiologist Radiology is the medical discipline that uses medical imaging Medical imaging is the technique and process of imaging Imaging is the representation or reproduction of an object's form; especially a visual representation (i.e., the form ...

radiologist
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. This is traditionally done by ...
, insertion of
chest drain A chest tube (chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural cavity, pleural space or mediastinum. It is used to remove air (pneumothor ...
s and
central venous catheters A central venous catheter (CVC), also known as a central 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 centrally locate ...
, insertion of PEG tubes using the push technique, insertion of the leads for an
artificial pacemaker A cardiac pacemaker (or artificial pacemaker, so as not to be confused with the cardiac pacemaker, natural pacemaker of the heart), is a medical device that generates electrical impulses delivered by electrodes to cause the heart muscle chambers ...
or
implantable cardioverter-defibrillator An implantable cardioverter-defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device implant (medicine), implantable inside the body, able to perform cardioversion, defibrillation, and (in modern versions) car ...

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, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survi ...
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 perforat ...

perforation
of the organ in question.
Infection An infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host A host is a person responsible for guests at an event or for providing hospitality during it. Host may ...

Infection
is a possible complication, and hence
asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria Pathogenic bacteria are bacteria Bacteria (; common noun bacteria, singular bacterium) are a type of Cell (biology), biological cell. ...
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 s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies from person to person and is appro ...
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 (; from Latin ''"little reed"''; plural ''cannulae'' or ''cannulas'') 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 ...

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 or tube, the guidewire is withdrawn. An introducer sheath can be used to introduce
catheter In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge) ...

catheter
s or other devices to perform endoluminal (inside the hollow organ) procedures, such as
angioplasty Angioplasty, 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 atherosclerosis ...
.
Fluoroscopy Image:Normal barium swallow animation.gif, A barium swallow exam taken via 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 i ...

Fluoroscopy
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 An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is t ...
may be used to visualize organs. Interventional procedures, such as thermoablation, angioplasty, embolisation or
biopsy A biopsy is a medical test A medical test is a medical procedureA 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 diagno ...

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. 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. This is traditionally done by ...
became a relatively risk-free procedure, and the field of
interventional radiology Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as Fluoroscopy, x-ray fluoroscopy, CT scan, computed tomography, magnetic resonance imaging, or ultra ...

interventional radiology
blossomed. Building on the work of Seldinger,
Charles Dotter Charles Theodore Dotter (14 June 1920 – 15 February 1985) was a pioneering US Blood vessel, vascular radiologist who is credited with developing interventional radiology. Dotter, with his trainee Melvin Judkins, Dr Melvin P. Judkins, described a ...
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 Epidemiology is the study and analysis of the distribution (who, when, and whe ...
developed
angioplasty Angioplasty, 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 atherosclerosis ...
.


References


External links


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