While managing a 68-year-old man with refractory septic shock in the intensive care unit, a physician prepares to obtain central venous access for continuous vasopressor administration. The physician decides to place a right internal jugular central venous catheter using the standard Seldinger technique. After donning maximal sterile barriers, prepping and draping the site, and visualizing the target vessel with real-time ultrasound, the physician must perform the catheter insertion. Arrange the following procedural steps of the Seldinger technique in the correct chronological order.
- 1Insert the introducer needle under continuous ultrasound guidance until venous blood is freely aspirated.
- 2Advance the flexible guidewire through the introducer needle and into the vessel lumen.
- 3Withdraw the introducer needle completely while maintaining the guidewire firmly in place.
- 4Pass the tissue dilator over the guidewire to expand the subcutaneous tissue tract, then remove the dilator.
- 5Thread the central venous catheter over the guidewire to its final depth, then completely remove the guidewire.
Answer
The correct sequence for the Seldinger technique is: needle insertion and blood aspiration, advancing the guidewire, removing the needle, passing the dilator, and finally threading the catheter.
The Seldinger technique is a foundational procedural skill for obtaining safe vascular access. The correct sequence relies on using a small-gauge introducer needle to minimize initial trauma. Once in the vessel, a flexible guidewire is advanced through the needle. The needle is then removed, leaving the wire to safely maintain the tract into the vein. A rigid dilator is temporarily passed over the wire to enlarge the tissue path, followed by the insertion of the definitive central venous catheter. Finally, the guidewire is removed to allow the catheter to function.
Step-by-Step Solution
Key Concept
Procedural steps of the Seldinger technique for central venous catheterization