Drainage Seldinger technique

Faster placement of drainage catheter compared to Seldinger technique is possible... 

Fig. 37.12a,b. Patient who had undergone resection of the pancreatic tail and developed an abscess in the resection area postoperatively (a). The Seldinger technique was used for placement of an 8-French drainage catheter within the fluid collection (b)... 

Fig. 37.13a,b. Patient (prone position) with a fever showing a presacral fluid collection 10 days after abdominoperineal rectum resection (a). An 8-French drainage catheter was inserted using the Seldinger technique, b Guide wire being introduced through an 18-G sheath under CT fluoroscopy... 

Mediastinal Abscess. Mediastinal abscesses are most often seen after cardiac surgery. Especially if a parasternal access is necessary, the preinterventional planning CT is performed in an arterial and a venous phase in order to visualize the internal mammary artery and vein. To avoid a pneumothorax, drainage placement has to be conducted after dissection of the parasternal soft tissue, using sterile saline. With respect to the large mediastinal vessels, CT guidance and the Seldinger technique are preferred for safe catheter placement. 

Trocar technique for easy-to-access fluid collections Seldinger technique for more sophisticated, i.e., deep or small fluid collections adjacent to neurovascular structures or bowels Sump and non-sump catheters Diameter of suitable drainage catheter (8-28 French) depends on viscosity of fluid and size of fluid collection. 

Pleural Effusion. The basic indication for drainage of pleural fluid collections is dyspnea in patients with malignant pleural effusions, while benign parapneumonic effusions are drained only exceptionally. Thoracocentesis can be performed with a small intravenous cannula as a temporary solution, or a small drainage catheter (8 French) using either the Seldinger or Trocar technique. The drainage catheter is connected to a three-way-stop-cock and a sterile evacuated bottle that drains the effusion continuously. 

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