An over-wire technique of catheter insertion to obtain safe percutaneous access to vessels and hollow organs.
The Seldinger method of guide-wire catheterization was originally described by Sven Ivar Seldinger, a Swedish radiologist, as an arterial cannulation method for performing arteriography. Subsequent modifications have adapted the technique for use in venous catheterization. The Seldinger technique allows for the insertion of a catheter larger in diameter than the needle originally utilized.
The Seldinger guide wire technique uses are myriad and include central venous cannulation, angiography, percutaneous transtracheal ventilation, peripheral arterial and venous cannulation as well as the insertion of chest drains, PEG tubes leads for an artificial pacemaker leads; and numerous other interventional medical procedures.
History of the Seldinger Technique
1929 – Portuguese urologist, Dr. Reynaldo dos Santos, decides to stick a needle directly into the aorta and inject contrast for the world’s first translumbar aortogram. Technique: Insert needle just below the 12th rib and 4 fingerbreadths to the left of the spinal process. (published 1933)
1941 – Cuban radiologist Pedro L. Fariñas (1892–1951) was a pioneer of pioneer of arterial catheterization. He described a method in which a urethral catheter was passed up into the aorta through a trocar inserted in the exposed femoral artery. His catheter-based technique for arteriography of the aorta still required surgery.
In order to avoid the blind puncturing of the aorta, we recommend the arteriographic study of the abdominal aorta and its branches by the puncture and catheterization of the femoral artery at Scarpa’s triangle. After local anesthesia the femoral artery is exposed by blunt dissection, mounted in two catguts, and punctured with a trocar through which a catheter is passed, it being introduced to the desired level in the aorta.Farinas 1941
1948 – Stig Radner catheterized the exposed and ligated radial artery and performed vertebral angiography and later thoracic aortography. He studied the aorta through catheters introduced via left radial artery cutdowns. He presented before the meeting of the Swedish Society for Internal Medicine the use of a wire guide (C) to stiffen the catheter, and to make possible more accurate placement of the catheter tip.
1951 – Edmund Converse Peirce II (1917-2003) described of a method of percutaneous introduction of a catheter for aortography. He punctured the femoral artery with a large bore (12-15 ga.) needle and through it threaded a polyethylene catheter. This eliminated the need to expose an artery, or repair it after arteriography. The new flexible catheter allowed Seldinger to develop his technique.
By 1953, all the prerequisites for modern arteriography had been met: safe, water soluble contrast agents were widely available, as were wire guides and suitable catheters. Arteriography was clearly acceptable as worthwhile, even mandatory in some instances. The desirability of the percutaneous approach was generally recognized. What remained was for one man to unite these concepts comprehensively…
This modified technique involved inserting a needle through a side hole in a polyethylene catheter in order to introduce it, however he found this tube lacked the stiffness required to advance it once the needle was removed.
Originally Seldinger modified a technique devised by André Frédéric Cournand who developed cardiac catheterization. Following further failed modification using a piano wire to stiffen the tube, Seldinger was left with the three essential components; a needle, a wire and polyethylene tube. In April 1952 he was hit by a…
‘…sudden attack of common sense and knew what to do: needle in, guide-wire in through the needle, needle out, catheter in over the wire and finally removal of the guide wireSeldinger 1952
The artery exposure technique of catheterization is time-consuming, troublesome and may present certain risks.
There is a simple method, however, of using a catheter the same size as the needle, and which has been used at Karolinska Sjukhuset since April 1952. The main principle consists in the catheter being introduced on a flexible leader through the puncture hole after withdrawal of the puncture needleSeldinger 1953
a. The artery punctured. The needle pushed upwards. After local anaesthesia, the artery is punctured percutaneously at a relatively small angle. After puncture it is best to rotate the needle 180o and push it a little into the artery using the bleeding as a guide to ensure that the needle remains in the artery. Puncture of arteries smaller than the femoral artery is facilitated by using an inner needle as a guide over which the outer needle is directed into the artery.
b. The leader inserted. The supple tip of the leader is inserted a very short distance into the lumen of the artery through the needle.
c. The needle withdrawn and the artery compressed. The leader is held in place and the needle removed.
d. The catheter is threaded on to the leader; when the tip reaches the skin the free end of the leader must protrude from the catheter.
e. The catheter inserted into the artery. The catheter and leader are gripped near the skin through which they are inserted. The catheter enters the artery easily as an opening has already been made by the needle. The catheter and leader are pushed just far enough to ensure that the tip of the former is in the lumen of the vessel.
f. The leader withdrawn. The leader is removed and the catheter directed to the level required, after good arterial bleeding through the catheter has been obtained. The unsupported catheter is usually pushed up the vessel without difficulty, but occasionally the leader must be re-introduced into the catheter in order to support it. The leader should not be passed beyond the tip of the catheter.
Seldinger used his new technique to pioneer several new procedures including localization of parathyroid adenoma by arteriography; selective renal angiography; puncture of bile ducts for cholangiography and puncture of the liver and spleen for portal venography.
1963 – Charles Theodore Dotter (1920-1985) an American radiologist, is credited with being the first to realise the therapeutic potential of the Seldinger technique. Dotter inadvertently performed transluminal recanalisation of an occluded iliac artery whilst attempting retrograde aortography, and realising the significance of this work, he described percutaneous transluminal coronary angioplasty in 1964
- Pedro L. Fariñas (1892–1951)
- André Frédéric Cournand (1895-1988)
- Edmund Converse Peirce II (1917-2003)
- Sven Ivar Seldinger (1921–1998)
- Charles Theodore Dotter (1920-1985)
- Dos Santos R. L’artériographie en série. Bulletins et mémoires de la société nationale de chirurgie. 1933; 59: 35-39
- Dos Santos R. Technique de l’aortographie. Journal international de chirurgie. 1937; 2: 629-630
- Fariñas PL. A new technique for the arteriographic examination of the abdominal aorta and its branches. The American Journal of Roentgenology and Radium Therapy. 1941; 46(5): 641–645.
- Radner S. Thoracal aortography by catheterization from the radial artery; preliminary report of a new technique. Acta radiol. 1948 Feb 28;29(2):178-80
- Jönsson G. Thoracic aortography by means of a cannula inserted percutaneously into the common carotid artery. Acta radiol. 1949; 31: 376
- Radner S. Technical equipment for vasal catheterization. Acta radiol. 1949; 31: 152-154.
- Peirce EC II. Percutaneous femoral artery catheterization in man with special reference to aortography. Surgery, Gynecology & Obstetrics. 1951; 93: 56-74.
- Seldinger SI. Catheter replacement of the needle in percutaneous arteriography – a new technique. Acta Radiol 1953; 39: 368-376
- Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technic and a preliminary report of its application. Circulation 1964; 30: 654–70.
- Cunningham JJ, Thurber B. The abdominal aortogram: an historic perspective. Am J Roentgenol Radium Ther Nucl Med. 1972 Oct;116(2):441-4.
- Sternbach G. Sven Ivar Seldinger: catheter introduction on a flexible leader. J Emerg Med. 1990 Sep-Oct;8(5):635-7
- Higgs ZC et al. The Seldinger technique: 50 years on. Lancet. 2005 Oct 15-21;366(9494):1407-9
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