THE SELDINGER

TECHNIQUE
CHIDOCHASHE R MEDA H20181Y
AMANDA T CHIKAWA H210123C
PRIDE MURUNGWENI H210030W
OBJECTIVES:
1. DEFINITION
2. HISTORY AND ETYMOLOGY
3. USES
4. TECHNIQUE
5. COMPLICATIONS
DEFINITION
• The seldinger technique is a procedure used to obtain safe access to a
central vein thus it is the common and standard method used for
central vein catheterization.
HISTORY AND ETYMOLOGY
• The seldinger technique is an over-wire technique of catheter
insertion that was originally described by Sven Ivar Seldinger, a
Swedish interventional radiologist, as an arterial method for
performing arteriography in 1953.
• Before the introduction of this technique sharp large-bore trocars
were employed to gain arterial access, resulting in a high rate of
complications and limiting its use to larger arteries.
• While working at the Karolinska Hospital, Sven introduced a novel
method of gaining vascular access using a hollow needle, exchange
wire, and catheter, which enabled radiologists to perform
angiography in a relatively risk-free manner and thus lead to the
emergence of minimally invasive procedures.
USES
• DIGITAL SUBTRACTION ANGIOGRAPHY
• INSERTION OF CENTRAL VENOUS CATHETERS
• INSERTION OF CHEST DRAINS
• INSERTION OF PACEMAKER LEADS
• INSERTION OF IMPLANTABLE CARDIOVERTER-DEFRIBILLATORS
• INSERTION OF PEG TUBES
EQUIPMENT
1. SELDINGER NEEDLE:
• Mostly used 18 gauge angiographic needle
2. GUIDE WIRE:
• It’s a long and flexible, fine wire.
• They are the stainless steel metallic structures that guides the catheter through the blood
vessels for placements.
• They are used for interventional procedures
• Tips at the end of guide wire: straight and J-tipped to prevent subintimal dissection artery.
• Longer guide wire for selective angio vessels.
• Covered by a coating- Teflon, heparin and hydrophilic polymers.
3. DILATOR:
 Cont…

4. CATHETER:
• Is a tubular, thin, flexible instrument
• It can be inserted into the body cavity, duct or vessel
• They allow drainage, administration of fluid or gases, access by surgical
instruments
• Diameter- 3Fr=1mm
• Types of cathers:
1. straight: end hole only. For smaller vessels/minimal contrast
2. Pigtail: circular tip with multiple side holes. For larger vessels/ more
contrast
3. Head hunter tip: used for femoral approach to brachiocephalic vessels
4. Judkins catheters: right(lesser curve) and left(greater curve) for right
and left coronary arteries.
TECHNIQUE
• Preparation
• Desired vein punctured.
• Guide wire insertion
• Removal of needle
• Sheat/catheter insertion
• Guide wire removal .
1.Preparation
• Gather all the necessary equipment
• The appropriate catheter, guidewire, dilators (if required), syringes,
local anesthesia, sterile drapes, gloves, and a sterile field.
• Ensure that the patient is properly positioned and adequately
prepared for the procedure.
• Clean the desired site of puncture.
2.Anasthesia
• Administer local anesthesia to the site where the catheter will be
inserted.
• This is typically done using a small needle and a local anesthetic agent
to numb the skin and underlying tissues at the entry point.
• 3. Needle insertion
• Using aseptic technique, insert an appropriately sized needle into the
target vessel or cavity.
• The specific entry site will depend on the procedure being performed.
• For example, in central venous catheterization, the needle is usually
inserted into a vein in the neck, chest, or groin area.
4. Guidewire insertion
• Once the needle is correctly positioned within the vessel or cavity,
advance a guidewire through the needle and into the lumen.
• The guidewire is a thin, flexible wire that helps guide the subsequent
placement of the catheter.
• 5. Needle removal
• After the guidewire is in place, remove the needle while holding the
guidewire securely in position.
• Be careful to maintain the wire's position and prevent it from
unintentionally retracting or moving.
6.Dilator insertion(optional)
• In some cases, a series of dilators may be used to enlarge the tract
before inserting the catheter.
• The dilators are gradually inserted over the guidewire, each one larger
than the previous, to gently widen the opening.
• 7. Catheter insertion
• With the dilator(s) removed, thread the catheter over the guidewire
and advance it into the vessel or cavity.
• The catheter is carefully guided along the wire until it is properly
positioned.
8. Guide wire removal
• Once the catheter is securely in place, carefully remove the guidewire
by holding the catheter in place while withdrawing the wire through
the lumen.
• 9. Securement and connection
• Secure the catheter in place using appropriate fixation devices, such
as sutures or adhesive dressings.
• Connect the catheter to the appropriate tubing or system for the
intended purpose, such as an intravenous line or drainage system.
10.post-procedure verification
• Confirm correct catheter placement using imaging techniques, such as
fluoroscopy or X-ray, if necessary.
• Additionally, observe the patient for any signs of complications or
adverse reactions.
Catheterization method of percutaneous
femoral
• Puncturing of femoral artery is the most common catheterization approach
• It is easily accessible and is fairly large
• The seldinger technique is used for catheterization of the vessel
• The best entry level is at the apex of the femoral arch
• Introducing the needle above the arch result in missing the artery
• The femoral approach is indicated in studies of pathologic conditions such as:
Pelvic area
Head and neck angiography
Lower extremities
Other sites:

• Brachial approach: artery is punctured just above the elbow reducing

the risk of damaging the brachial plexus
• Radial approach: arterial point at the point of maximum pulsation,
near the styloid process
COMPLICATIONS
• HEMORRHAGE
• INFECTION AT THE PUNCTURE SITE
• PERFORATION OF VISCUS
• GUIDEWIRE EMBOLUS
• PSEUDOANEURYSM FORMATION
• THROMBUS FORMATION
• DISSECTION OF VESSEL
• CONTRAST REACTION