Seldinger Technique For Introducing Catheters
Percutaneously Into Vascular Channels
 

Sharp trocars were used earlier to create lumens through which devices could be passed. This had a high rate of complications. However, with the introduction of the Seldinger technique, angiography became a relatively risk-free procedure, and the field of interventional radiology blossomed. : Applications : Angiography Insertion of chest drains and central venous catheters, Insertion of PEG tubes using the push technique, Insertion of the leads for a artificial pacemaker or implantable cardioverter-defibrillator Numerous other interventional medical procedures.

Innovator

Dr. Sven-Ivar Seldinger, the world-renowned Swedish pioneer in angiography, was born in Mora, Sweden on April 19 in 1921. He gained his medical studies at the Karolinska Institute in the fall of 1940. After studying medicine at the karolinska in Stockholm he began his diagnostic radiology training at the Karolinska Sjukhuset in 1950.

Many sensed the great potential of angiography and although methods for introducing a catheter into an artery or vein were available, they were traumatic and involved considerable blood loss. This was the problem that Dr..Seldinger set out to solve. He submitted his initial and most important paper on percutaneous catheterization in 1953.

Technique

Dr. Seldinger came upon the ingenious idea of his new technique in 1952 as a young resident at the Karolinska. Dr. Seldinger has related the story about his discovery. The following is a quotation from “A Leaf out of the History of Angiography” (In: Pioneers in Angiography, M.E. Silvestre, F. Abecasis, J.A. Veiga-Pires eds. Elseviers Science Publishers [Biomedical Division], 1987). Seldinger writes, after giving a brief account on the state of the art in the early 1950s :

“Thus, there was obviously a need for an improved percutaneous method for aortography, and one of the requirements to the solution was an increased bore of the catheter. Such an increase would be substantially beneficial. According to the law of Poiseuille, the rate of flow through a long narrow tube—all other factors constant—is approximately proportional to the fourth power of the diameter. When doubled, the time of injection could be divided by 16 ! There existed a puncture instrument, named after Cournaud, consisting of an inner sharp needle in an outer blunt cannula, the edge exceeding the cannula by one or two mm. One alternative was to use a flexible catheter instead of the cannula, but it would certainly be tricky to handle an inner needle, half a meter long. I avoided this trouble by cutting a side hole on a polyethylene catheter at such a level that a cutting needle of convenient length, when inserted through it, exceeded the tip of the catheter by one or two mm. After some moulding of the catheter and a minute incision in the skin, this instrument could be inserted into the artery by percutaneous puncture.

Some obvious disadvantages were inherent in this technique. For instance, the thin walled catheters were so flexible that it was sometimes impossible to advance them further into the vessel. This difficulty could be overcome: When intravascular position was obtained, the needle could be withdrawn from the side hole and replaced by a semi-flexible metal wire which was introduced through the entire length of the catheter to support it. Now! After an unsuccessful attempt to use this technique I found myself disappointed and sad, with three objects in my hand—a needle, a wire and a catheter—and ... in a split second I realized in what sequence I should use them:

Needle in-wire in-needle off-catheter on wire-catheter in-catheter advance-wire off. (A needle is introduced; a guide wire passed along the needle lumen and the needle is removed. The catheter is then fed over the wire, the wire is then removed.)

I have been asked how this idea turned up and I quote Phokion, the Greek. ‘I had a severe attack of common sense.’ With the ‘beginners luck,’ the first angiography performed with this technique was successful. A subclavian arteriography, with one single exposure, the catheter introduced through the brachial artery after puncture at the cubital level revealed a mediastinal parathyroid adenoma, unsuccessfully searched for by the surgeon at a former operative exploration.”

The seldinger technique was, because of its simplicity, adopted worldwide and since its conception has served millions, permitting safe, simple catheterization of virtually every important vessel in the body.

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