Seldinger technique

A 67-year-old woman was provided with a totally implantable venous device in the right subclavian vein by the Seldinger technique with a peel-away sheath. The device was used for a course of chemotherapy. After about 1 month there was subcutaneous extravasation of the drug. A chest X-ray showed that the sihcone catheter had fractured below the clavicle and the distal portion of the catheter had embolized into the right atrium. The fragments were removed. 

This pinched-off effect appears to be due to narrowing of the catheter as it passes over the first rib and beneath the clavicle, when using the Seldinger technique, but it is usually only observed after long-term use. The authors recommended that the cephalic cut-down (Seldinger) technique is best avoided. 

In stable and cooperative patients, the diagnostic arteriography is performed under local anesthesia via a transfemoral access and in the classical Seldinger technique. Celiac trunk and the superior mesenteric artery (SMA) are catheterized with preshaped single-use 4- or 5-F catheters of the Cobra or side-winder type. lodinated nonionic iso-osmolar contrast medium (25-35 ml at a rate of 4-6 ml/s) is injected by a power injector into the celiac trunk and SMA. In patients with renal insufficiency, contrast allergy or hyperthyroidism gadolinium chelates (MRI contrast medium) have been suggested as a substitute for iodinated contrast medium [53], but reports on its use in the visceral arteries are still awaited. 

Central venous catheters (CVC) are directly inserted by different techniques (mostly Seldinger technique) into a... 

Cardiologists have used the Seldinger technique for percutaneous access for years, hi this technique, a large-bore needle ( 18 gauge) is used to percutaneously puncture the vascular structure. A guidewire is introduced through the needle into... 

Seldinger technique are used. Because this technique directly visualizes the axillary vein, it has been used with considerable success for both pacing and defibrillator electrodes. There have been no pneumothoraces. The technique can be carried out transcutaneously or through the incision on the surface of the pectoralis muscle. 

Air embolism is a complication associated with the use of the Seldinger technique with a percutaneous sheath set. Air embolism is a well-known, well-documented complication of the percutaneous approach. To avoid this problem, it has been recommended that the patient be well hydrated and placed in the Trendelenburg position. The most important step in prevention is awareness on the part of the implanting physician for the risk of air embolization. There are many steps that may be taken to avoid this complication (Table 4.21) (192). The time of greatest risk is when the dilator is removed from the sheath set. In patients with a volume-overload state, there is little or no risk. On the other hand, an elderly dehydrated patient who has been NPO for many hours is at risk for serious air embolization. It is reconunended that prior to any percutaneous pacemaker or ICD procedure, the patient be maintained in a mild state of overhydration. The patient s state of hydration should be assessed just prior to removal of the dilator. 

Seldinger technique. First, an 18-G long-dwell sheath is inserted into the fluid collection, followed by a 0.035/0.038-in. guide wire, which is consecutively coiled... 

Table 37.5. Advantages and disadvantages of the Trocar and the Seldinger techniques...

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. 

The HCC nodules were localized on computed tomographic (CT) scans and the injection site was infiltrated with 20 ml of 1% lidocaine. Under CT guidance, up to four sheaths were inserted using the Seldinger technique. A special heat-resistant protective fiber was then introduced. For the positioning of the applicators we routinely used the CT guidance in all patients this is because of later procedures and because it allows immediate reaction in cases of bleeding or pneumothorax. After the patient was positioned on the MRI table, the laser fiber was inserted into the protective catheter. MR sequences... 

Conventional Seldinger technique is generally used for the majority of the procedures, and a femoral sheath with hemostatic valve (4 to 9 French) is placed into the femoral artery to allow the exchange of the catheters, reducing the trauma to the artery. 

Seldinger technique with fluoroscopy Penetration with needle may lessen blind risk of organ or vascular injury Similar to blind percutaneous... 

The percutaneous method has been simplified with a modified Seldinger technique. Although also a blind procedure, the risk of injury to abdominal structures is reduced because of the use of needle penetration followed by dilation using a blunt plastic dilator. The operator must be certain to aspirate while placing the needle in order to assess for blood or intestinal fluids. 

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