Seldinger technique. Initially used as a technique for percutaneous canalization of central venous lines ( internal jugular , femoral, and subclavian).
[ hide ]
- 1 Procedure
- 2 Description of technique
- 3 Complications:
- 1 thrombosis
- 2 Obstruction
- 3 Others
- 4 Source
The procedure was described by Seldinger in the 1950s. Currently the indications for the use of this technique have been extended to non-vascular procedures (placement of pleural, pericardial drains, etc.). Localization of the vein is performed using a fine needle. Once the blood flow has been obtained, a flexible metal guide with a soft tip is inserted through the needle (or the peripheral venipuncture catheter) and a catheter is advanced, leaning on the guide, holding it firmly so that it does not slide into the venous territory.
When the catheter has progressed sufficiently (it will depend on the access, age and size of the patient), the guide is removed without dragging the catheter that remains in the intravascular position. An imaging technique (generally chest radiography , echocardiography …) must be performed to check your situation. In this same way, the appropriate area is located to place the pleural, pericardial drains, etc. and after puncturing with a needle, the guide and the drainage catheter are inserted, checking their correct location.
Description of the technique
- The distance from the puncture site to the entrance to the right atrium is measured . The skin is disinfected and after purging the catheter with heparinized serum, we sedate the patient and start venipuncture with a needle or cannula over a needle and syringe with heparinized serum, always aspirating until blood refluxes.
The cannula is then slid over the needle or the needle is held firm where it flows with fluidity and the soft and flexible guide is inserted up to the distance that we have measured or until the recording of the electrocardiogram detects any extrasystole (the guide is removed a few centimeters).
- The needle or cannula is removed and we leave the guide.
- Make an incision in the skin
- With the scalpel . Insert the dilator through the guide advancing and rotating it only a few centimeters (skin and subcutaneous tissue) until we have reached the vessel to avoid injury.
- Remove the dilator and leave the guide on which it slides again, now the catheter that does not go completely under the skin until it has one end of the guide in our hands (through the end of the catheter).
- The guidewire is removed and all catheter lumens are checked for reflux.
- A control radiograph is performed and after checking the correct location of the catheter, it is fixed to the skin with stitches.
It is also a very frequent complication, sometimes underestimated. There are factors that increase the risk of thrombosis:
- Two or more venipunctures to channel the line
- The type of fluid infused (more common with parenteral nutrition).
- Hypercoagulable states.
There is a clear association between septicemia and thrombosis although it is unknown what comes first. It can be prevented using heparin-impregnated catheters. And it can be treated with thrombolytics and / or heparin.
It can be total (impossibility to extract and infuse) or partial (impossibility to extract) is caused by accumulation of fibrin. Treatment consists of administering urokinase 5000U / ml in the catheter purge volume (0.3-0.5-1 ml) and leaving it on for 30-60 minutes.
- Catheter migration
- Catheter break
- Wide mediastinum (if the catheter is positioned there and infuses there).