Seldinger technique

The Seldinger technique is a medicalprocedure to obtain safe access to blood vesselsand other hollow organs. It is named afterDr Sven-Ivar Seldinger (1921-1998), a Swedishradiologistfrom Mora, Dalarna County, who introduced the procedure in 1953.

Description

The desired vessel or cavity is punctured with a sharp hollow needle called a trocar, with ultrasoundguidance if necessary. A round-tipped guidewireis then advanced through the lumenof the trocar, and the trocar is withdrawn.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 After passing a sheath of tube, the guidewire is withdrawn.

If a sheath is used, it can be used to introduce cathetersor other devices to perform endoluminal (inside the hollow organ) procedures, such as angioplasty. Fluoroscopymay be used to confirm the position of the catheter and to manoeuvre it to the desired location. Injection of radiocontrastmay 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Upon completion of the desired procedure, the sheath is withdrawn.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 drainsand central venous catheters, and numerous other interventional medical procedures.

Complications

The initial puncture is with a sharp instrument, and this may lead to hemorrhageor perforationof the organ in question. Infectionis a possible complication, and hence asepsisis practiced during most Seldinger procedures.

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 (Higgs et al 2005). However, with the introduction of the Seldinger technique, angiographybecame a relatively risk-free procedure, and the field of interventional radiologyblossomed.

Building on the work of Seldinger, Charles Dotterand Andreas Gruentzigdeveloped angioplasty.

References

• Higgs ZC, Macafee DA, Braithwaite BD, Maxwell-Armstong CA. The Seldinger technique: 50 years on. Lancet2005;366:1407-9. PMID 16226619.
• Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol 1953;39:368-76. PMID 13057644.

External link

• Illustrations showing the steps of the Seldinger technique(505 KB PDF)

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It uses material from the http://en.wikipedia.org/wiki/Seldinger+technique Wikipedia article Seldinger technique.