Seldinger Technique & Modified Seldinger Technique

Summary

This video explains the Seldinger and modified Seldinger techniques for safe vascular access. It describes step-by-step Seldinger: hollow needle puncture, confirmation by blood flash, guidewire insertion, needle removal, catheter advanced over the guidewire, and guidewire removal to leave a catheter sheath. It provides historical context—Sven Ivar Seldinger’s 1953 publication—and contrasts older surgical trocar methods with their higher complication rates. The modified Seldinger, commonly used for neonatal central lines, uses a fine catheter over the needle to prevent displacement during guidewire insertion. The video highlights these techniques’ impact across interventional specialties and references related procedural videos.

Takeaways

• 😀 Seldinger technique is a method to safely gain access to blood vessels.
• 😀 The procedure starts with a hollow needle being inserted into the blood vessel until blood is seen.
• 😀 A guidewire is then introduced through the needle, followed by the removal of the needle.
• 😀 A catheter is advanced over the guidewire, and once in place, the guidewire is removed.
• 😀 The Seldinger technique has revolutionized access to blood vessels and hollow organs.
• 😀 The technique was first published in 1953 by Sven Ivar Seldinger, a Swedish radiologist.
• 😀 Before Seldinger's technique, vascular access was done through surgery with a sharp trocar.
• 😀 Seldinger's technique greatly reduced complications compared to older methods.
• 😀 The modified Seldinger technique is typically used for central venous line insertion in neonates.
• 😀 In the modified technique, a fine catheter over the needle is used to prevent needle displacement during guidewire insertion.
• 😀 The procedure for the modified technique is similar to the Seldinger technique but adapted for the small vessels in neonates.

Q & A

What is the Seldinger technique?

The Seldinger technique is a medical procedure used to obtain safe access to blood vessels. It involves inserting a hollow needle into the vessel, introducing a guidewire through the needle, and then passing a catheter over the guidewire into the vessel.

How is the Seldinger technique performed?

First, a hollow needle is slowly inserted into the blood vessel. When a splash of blood is seen, the needle is held in place, and a guidewire is introduced through the needle. Once the guidewire is in position, the needle is removed, and a catheter is advanced over the guidewire. The guidewire is then removed, leaving the catheter in place.

Why is the Seldinger technique important in medical procedures?

The Seldinger technique revolutionized vascular access by providing a safer and less invasive method to access blood vessels, allowing for percutaneous procedures. It has been fundamental in interventional radiology, cardiology, and many other fields.

Who invented the Seldinger technique?

The Seldinger technique was invented by Sven Evar Seldinger, a Swedish radiologist. He first published his method for obtaining percutaneous access to blood vessels in 1953.

What was the state of vascular access before the Seldinger technique?

Before the Seldinger technique, vascular access required surgically exposing the desired artery and inserting a sharp, wide-bore trocar. This procedure had a high complication rate and was limited to larger arteries.

What is the modified Seldinger technique, and when is it used?

The modified Seldinger technique is a variation of the original method, commonly used for inserting central venous lines in neonates. It addresses the challenge of small vessels in neonates by using a fine catheter over the needle to prevent needle displacement during guidewire insertion.

How does the modified Seldinger technique differ from the original technique?

In the modified Seldinger technique, a fine catheter is used to puncture the vein, rather than the needle. After the needle is removed, the fine catheter serves as the conduit for introducing the guidewire, making the process more stable for neonates with small blood vessels.

Why is the modified Seldinger technique specifically useful for neonates?

Neonates have very small veins, which makes it difficult to maintain the needle's position during the insertion of the guidewire. The modified technique uses a fine catheter to prevent displacement and ensures safer access to their blood vessels.

What are some common applications of the Seldinger technique?

The Seldinger technique is widely used for procedures like central venous catheter insertion, femoral arterial line placement, and other vascular access procedures in interventional radiology, cardiology, and anesthesiology.

What are some potential complications that the Seldinger technique helps to avoid?

The Seldinger technique reduces complications associated with traditional vascular access methods, such as bleeding, infection, and vessel damage, by providing a less invasive and more controlled approach.