From Big Medical Encyclopedia

SELDINGERA METHOD (S. Seldinger; synonym puncture catheterization of arteries) — introduction of a special catheter to a blood vessel by its transdermal puncture with the diagnostic or medical purpose. It is offered by Seldinger in 1953 for a puncture of arteries and the selection arteriography. In the subsequent S. m began to use also for a puncture of veins (see. Catheterization of veins puncture ).

Page of m. apply for the purpose of catheterization and a contrast research of auricles and ventricles of heart, an aorta and its branches, administration of dyes, radio pharmaceuticals, pharmaceuticals, donor blood and blood substitutes in an arterial bed, and also in need of a repeated research of an arterial blood.

Contraindications same, as well as for catheterizations of heart (see).

The research is conducted in the X-ray operating room (see. Surgery block ) by means of the special tools entering Seldinger's set — a trocar, perished whom the conductor, a polyethylene catheter, etc. Instead of a polyethylene catheter it is possible to apply Edman's catheter — a X-ray contrast elastic plastic tubule of red, green or yellow color depending on diameter. Length and diameter of a catheter are selected proceeding from research problems. The internal acute end of a catheter is densely adjusted to the outer diameter of the conductor, and outside — to the adapter. The adapter is connected to the syringe or the measuring device.

Usually S. of m. apply for the selection arteriography what make a transdermal puncture more often than the right femoral artery for. The patient is stacked on a back on a special catheterization table of heart and take aside him the right leg a little. Previously shaved right inguinal area is disinfected, and then isolated sterile sheets. The left hand probe the right femoral artery below an inguinal sheaf at once and fix its index and average fingers. Anesthesia of skin and hypodermic cellulose is produced by 2% solution of novocaine by means of a fine needle so that not to lose feeling of a pulsation of an artery. A scalpel make an incision skin over an artery and enter a trocar, a tip to-rogo try to grope the pulsing artery. Having inclined the outside end of a trocar to skin of a hip at an angle 45 °, puncture with bystry short advance a front wall of an artery (fig., a). Then the trocar is inclined even more to a hip, remove from it mandrin and insert the conductor towards to a stream of scarlet blood, the soft end to-rogo is advanced in a gleam of an artery under an inguinal sheaf on 5 cm (fig., b). Through skin an index finger of the left hand fix the conductor in a gleam of an artery, and take a trocar (fig., c). Pressing of a finger fix the conductor in an artery and prevent formation of a hematoma in the field of a puncture.

the Diagrammatic representation of stages of transdermal puncture catheterization of an artery by Seldinger's method: and — a transdermal puncture of an artery a trocar; — through a trocar the conductor is entered into a gleam of an artery; in — removal from an artery of a trocar; the conductor which remained in a gleam of an artery is pressed outside by a finger; — on the conductor the catheter is entered into a gleam of an artery; 1 — skin and hypodermic cellulose; 2 — a gleam of an artery; 3 — a trocar; 4 — mandrin; 5 — the conductor; 6 — a catheter.

Put on a catheter with the tip pointed and densely adjusted to diameter of the conductor the outside end of the conductor, advance it to skin of a hip and on the conductor enter into a gleam of an artery (fig., d). The catheter together with the speaker from it a soft tip of the conductor is advanced under control of the x-ray screen depending on research objectives (the general or selection arteriography) in the left departments of heart, an aorta or one of its branches. Then enter radiopaque substance and make a series of roentgenograms. In need of registration of pressure, capture of the item of uniforms of blood or administration of medicinal substances the conductor from a catheter is removed, and the last is washed out isotonic solution of sodium chloride. After the end of a research and extraction of a catheter to the place of a puncture apply a compressing bandage.

Complications (a hematoma and thrombosis in the field of a puncture of a femoral artery, perforation of walls of arteries, aortas or hearts) at the m which is technically correctly executed by S. meet seldom.

See also Arteriography .

Bibliography: Petrovsky B. V., etc. Belly aortografiya, Vestn. hir., t. 89, No. 10, page 3, 1962; S e 1 d i p-g e of S. I. Catheter replacement of the needle in percutaneous arteriography, Acta radiol. (Stockh.)., v. 39, p. 368, 1953.

V. V. Zaredky.