The Seldinger technique is the most common method used for the insertion of a central intravenous (IV) line. Central venous catheters or lines are placed in the following locations:
- Internal jugular vein
- Subclavian vein
- Femoral vein
- The peripheral vein in PICC
Seldinger technique, however, is not restricted to central venous line placement. It is also commonly used in placement of an arterial line [radial or femoral artery are most common sites].
The Seldinger technique is the mainstay of vascular and other luminal access when prolonged vascular access is required.
The Seldinger technique was first described in 1953 by Sven-Ivar Seldinger. Before this technique, sharp large-bore trocars were employed for access and the method was associated with complications.
Seldinger technique uses a hollow needle, exchange wire, and catheter which reduces risks and enhances placements.
Uses of Seldinger Technique
The majority of interventional diagnostic and therapeutic radiological procedures employ the Seldinger technique for initial vascular access. It is mainly employed in following settings.
- Digital subtraction angiography
- Insertion of central venous catheters
- Insertion of chest drains
- Insertion of pacemaker leads
- Implantable cardioverter-defibrillators
- Insertion of Percutaneous endoscopic gastrostomy
Procedure of Seldinger Technique
Clean and prepare the desired site.
The desired vessel or cavity is punctured using a trocar (hollow needle).
Enter the skin at approximately a 45-degree angle.
Once the needle is in, start pulling back on the plunger of the syringe and the blood would enter the syringe as it pierces the vessel.
Once blood starts to enter into the syringe, stop advancing the needle.
Remove the syringe while the needle is stabilized by the other hand.
The blood from artery would be pulsating and bright red in cases of arterial access. Keep in mind that if venous access is desired, this indicates that the needle is in an artery.
Prevent blood loss by placing thumb over the hub. This also prevents air from entering the vessel.
Stabilize the needle in place, insert the guide wire into the hub and advance. This will place the guidewire into the vessel.
The length the guide wire to be advanced would vary with the anatomical location and type of IV line being placed.
When guidewire has been advanced to the desired length, continue to hold onto the guide wire and remove the needle.
Enlarge the skin entrance for the catheter using surgical blade numbered 11. Alternatively, a dilator can be used.
Hold the guidewire and, place the distal aspect of the IV catheter over the tip of the guidewire and advance the catheter until the guide wire comes out of the IV catheter’s other end.
Hold the guidewire and advance the catheter into the vessel.
Once the catheter is in the vessel, gently pull the guide wire out.
Verify that the catheter is in the vessel by withdrawing blood using a syringe.
Once confirmed, flush all ports with normal saline.
Secure the IV catheter in place.
Apply occlusive dressing.
An x-ray would confirm the internal placement of the catheter.
- Failure of the procedure
- Vessel perforation [or visceral perforation]
- Guidewire embolus
- Pseudoaneurysm formation
Note: All images taken from Wikipedia article of the same name and are under WTFPL.
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