Seldinger technique
The Seldinger technique or Seldinger technique is a method of puncturing of blood vessels for the purpose of catheterization . It was developed in 1953 by the Swedish radiologist Sven-Ivar Seldinger to insert angiography catheters into blood vessels. It is used, among other things, in arteriography and coronary angiography , but also in laying arterial and central venous accesses.
Properties of the Seldinger wire
The Seldinger wire consists of a very tightly screwed steel wire. The windings make it very flexible. Often the tip is bent back in a semicircle (J-shape) in order to avoid perforation of the vessel wall from the inside. Longer Seldinger wires are encased in a circularly curved plastic tube for better handling.
Action
The patient is positioned depending on the vessel to be punctured, in the vast majority of cases in the supine position. The puncture region is first treated with a skin antiseptic , then covered with a perforated cloth. Then the infiltration takes place with a local anesthetic . The vessel is punctured at the appropriate point (e.g. on the neck or arm) with a puncture cannula. The position in the blood vessel (intravascular position) can be identified by the blood filling in the rear part of the cannula. After removing the stylet , a guide wire is advanced through the cannula, which is now in the blood vessel. In many cases, this is done under fluoroscopy in order to be able to follow the position of the wire. The puncture cannula is then removed while the guide wire is fixed. The vessel must be compressed at the puncture site and it must be ensured that the position of the wire remains unchanged. Depending on the caliber of the catheter to be inserted (or drainage or sheath ), the puncture channel must first be expanded using a dilator in order to facilitate the introduction. The sheath or catheter (e.g. CVC ) is then advanced over the wire to its target position. The guide wire is then removed and the sheath (or catheter or drain) is flushed through again.
The Seldinger technique is still used today to create arterial vascular access and central venous catheters. The technique is also used to puncture other anatomical structures (e.g. exposure of the biliary tract , abscess drainage, etc.).
Complications
- Incorrect puncture: The puncture cannula is not in the target structure (in the target vessel). Either it lies in the subcutaneous fat tissue, in the connective tissue in another vessel, in a neighboring nerve or organ.
- Bleeding: The cannula can injure the target vessel, which can lead to bleeding, especially with arterial punctures. The bleeding may initially go undetected and only show up hours later through hemodynamic instability.
- Dissection: When the cannula or the guide wire is advanced, the vessel wall can be split and the catheter advanced within the vessel wall. This is called an iatrogenic dissection. To avoid this complication, a guide wire with a particularly soft tip, usually a Bentson wire , is used.
- Vascular occlusion: Thrombosis can occur due to the vascular wall injury . This can lead to closure locally. In the case of an artery , however, it is possible that the thrombus will be carried to the periphery and cause a peripheral embolic occlusion there. In the case of a vein procrastination is to centrally possible thrombus stuck in a pulmonary artery, the result is pulmonary embolism . Finally, dissection of a vessel can also lead to complete occlusion.
- Nerve and organ injury: In the event of a faulty puncture, adjacent nerves or organs can be injured.
literature
- SI Seldinger: Catheter replacement of the needle in percutaneous arteriography; a new technique. In: Acta radiologica. Volume 39, Number 5, May 1953, pp. 368-376, ISSN 0001-6926 . PMID 13057644 . ( Article , PDF file).
Web links
- Flash animation of the Seldinger technique (FRCA.co.uk)
