The Seldinger technique is a medical procedure

Medical procedure

A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.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

Blood vessel

The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

s and other hollow organ

Organ (anatomy)

In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

s. It is named after

Eponym

An eponym is the name of a person or thing, whether real or fictitious, after which a particular place, tribe, era, discovery, or other item is named or thought to be named...

 Dr. Sven-Ivar Seldinger (1921-1998), a Swedish

Sweden

Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....

 radiologist

Radiology

Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

 from Mora, Dalarna County

Dalarna County

Dalarna County is a county or län in middle Sweden. It borders the counties of Jämtland, Gävleborg, Västmanland, Örebro and Värmland. It is also bordered by the Norwegian counties of Hedmark and Sør-Trøndelag in the west...

, who introduced the procedure in 1953.

Description

The desired vessel or cavity is punctured with a sharp hollow needle called a trocar

Trocar

A trocar is a medical instrument with a sharply pointed end, often three-sided, that is used inside a hollow cylinder to introduce this into blood vessels or body cavities...

, with ultrasound

Medical ultrasonography

Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

 guidance if necessary. A round-tipped guidewire is then advanced through the lumen

Lumen (anatomy)

A lumen in biology is the inside space of a tubular structure, such as an artery or intestine...

 of the trocar, and the trocar is withdrawn. A "sheath

Sheath

Sheath may refer to:* Scabbard, a sheath for holding a sword, knife, or other large blade, as well as guns, such as rifles.* The outer covering of a cable* Condom, a kind of contraception* Debye sheath, a layer of a plasma in physics...

" 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

Nephrostomy

A nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system ....

). After passing a sheath of tube, the guidewire is withdrawn.

A sheath can be used to introduce catheter

Catheter

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

s or other devices to perform endoluminal (inside the hollow organ) procedures, such as angioplasty

Angioplasty

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...

. Fluoroscopy

Fluoroscopy

Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...

 may be used to confirm the position of the catheter and to manoeuvre it to the desired location. Injection of radiocontrast

Radiocontrast

Radiocontrast agents are a type of medical contrast medium used to improve the visibility of internal bodily structures in an X-ray based imaging techniques such as computed tomography or radiography...

 may be used to visualize organs. Interventional procedures, such as thermoablation

Catheter ablation

Catheter ablation is an invasive procedure used to remove a faulty electrical pathway from the hearts of those who are prone to developing cardiac arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardias and Wolff-Parkinson-White syndrome.It involves advancing several...

, angioplasty, embolisation or biopsy

Biopsy

A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

, 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 drains and central venous catheters, insertion of PEG

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. The procedure is an alternative to surgical gastrostomy insertion, and...

 tubes using the push technique, insertion of the leads for an artificial pacemaker

Artificial pacemaker

A pacemaker is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart...

 or implantable cardioverter-defibrillator

Implantable cardioverter-defibrillator

An implantable cardioverter-defibrillator is a small battery-powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation and ventricular tachycardia. The device is programmed to detect cardiac arrhythmia and correct it...

, and numerous other interventional medical procedures.

Complications

The initial puncture is with a sharp instrument, and this may lead to hemorrhage or perforation

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 are called a perforation...

 of the organ in question. Infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

 is a possible complication, and hence asepsis

Asepsis

Asepsis is the state of being free from disease-causing contaminants or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery or medicine to prevent infection...

 is practiced during most Seldinger procedures.

Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable complication.

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. However, with the introduction of the Seldinger technique, angiography became a relatively risk-free procedure, and the field of interventional radiology

Interventional radiology

Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...

 blossomed.

Building on the work of Seldinger, Charles Dotter and Andreas Gruentzig

Andreas Gruentzig

Andreas Roland Grüntzig was a German cardiologist who first developed successful balloon angioplasty for expanding lumens of narrowed arteries.-Angioplasties:...

 developed angioplasty

Angioplasty

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...

.

External links

• Flash animation of the Seldinger technique (FRCA.co.uk)