Seldinger technique

The Seldinger technique or the Seldinger method is a method for puncturing blood vessels for the purpose of catheterization. It was developed in 1953 by the Swedish radiologist Sven- Ivar Seldinger to introduce angiographic catheter into the blood vessels. It is used inter alia in the arteriography and coronary angiography as well as the exposure of arterial and central venous access.

Properties of the Seldinger wire

The Seldinger wire consists of a very closely spirally wound steel wire. He is very flexible through the turns. Often the tip is semi-circular bent back (Y - shape ) to a perforation of the vessel wall to prevent from the inside. Longer Seldinger wires are sheathed for better handling in a circular curved plastic tube.

Procedure

The patient positioning is carried out depending on the punctured vessel, in most cases in the supine position. The injection region is first washed sterile, then covered using a perforated cloth. Then follows the infiltration by local anesthetic. The vessel (for example the neck or arm) punctured in the corresponding position with a puncture needle. Its location in the blood vessel ( intravascular position ) is recognizable by blood filling the back of the cannula. After removal of the stylet, a guidewire is advanced through the now lying in the blood vessel the cannula. This is often done under fluoroscopy to track the position of the wire can. The puncture needle is then removed under fixation of the guidewire. In this case the vessel at the puncture site is to compress and strictly to ensure that the position of the wire remains unchanged. Depending on the caliber of the catheter to be introduced (or drains or the lock ) must be previously dilated by dilator of the branch canal to facilitate the introduction. Thereafter, the sheath or the catheter is advanced (for example central venous catheter ) through the wire to its target position. Then the guide wire is removed and the lock (or catheter or drain ) flushed again.

The Seldinger technique is used to this day to the plant of arterial vascular access and central venous catheters. But technology is also used in the puncture of other anatomical structures are used ( eg display of the biliary tract, abscess drainage, and others).

Complications

• Faulty puncture: The puncture needle is not in the target structure ( target vessel ). Either it is in the subcutaneous fatty tissue in the connective tissue in another vessel in an adjacent nerve or organ.
• Circulation: By cannula, the target vessel may be injured, which may lead to bleeding, especially in the arterial puncture. The bleeding may initially go undetected and show until hours later by hemodynamic instability.
• Dissection: When pushing the cannula or of the guide wire, the vessel wall may be cleaved and the catheter is advanced within the vessel wall. This is referred to as iatrogenic dissection. To avoid this complication, a guide wire with extra soft tip, usually a Bentson wire used.
• Vessel closure: Due to the vessel wall injury thrombosis can occur. This can lead locally to closure. However, it is possible that the thrombus is carried off in the case of an artery in the periphery and there causes a peripheral embolic occlusion. In the case of a vein the spread to central, possible thrombus remains in a pulmonary artery hang, it comes to pulmonary embolism. Finally, a dissection of a vessel to complete occlusion lead.
• Nerve and organ injury: In the event of a failure puncture adjacent nerves or organs can be injured.