Seldinger Technique

Description

An over-wire technique of catheter insertion to obtain safe percutaneous access to vessels and hollow organs.

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)

1941Fariñas

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 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.

Radner Technical equipment for vasal catheterization 1949

Fig. 1. Technical equipment for vasal catheterization. Radner 1949

1951 – Converse E. Peirce II 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 wire

Seldinger 1952

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.

1953 Seldinger technique original-article
Fig. 2. Seldinger SI. Acta Radiol 1953;39:370

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.

1963 – Charles T. Dotter, 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

Associated Persons
References

Original articles

Review articles


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the names behind the name

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist  Emergency Medicine, Prince of Wales Hospital. Lead author of Lead author of Emergency Procedures App | Twitter |

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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