Seldinger technique
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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.
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[edit] 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 A round-tipped guidewire is then advanced through the lumen of the trocar, and the trocar is withdrawn.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 After passing a sheath of tube, the guidewire is withdrawn.
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Upon completion of the desired procedure, the sheath is withdrawn.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.
[edit] Uses
The Seldinger technique is used for angiography, insertion of chest drains and central venous catheters, insertion of PEG tubes using the push technique, and numerous other interventional medical procedures.
[edit] 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.
[edit] 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, angiography became a relatively risk-free procedure, and the field of interventional radiology blossomed.
The Seldinger technique was mentioned in an episode of Scrubs, wherein an older doctor recommended an outdated treatment instead of a 'modified Seldinger'. Ignoring his own medical training and instincts, the main character performs a cutdown, injuring someone in the process.
Building on the work of Seldinger, Charles Dotter and Andreas Gruentzig developed angioplasty.
[edit] References
- Higgs ZC, Macafee DA, Braithwaite BD, Maxwell-Armstong CA. The Seldinger technique: 50 years on. Lancet 2005;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.
[edit] External link
- Flash animation of the Seldinger technique (FRCA.co.uk)
