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January 31, 1977

Percutaneous Catheter Introduction: The Seldinger Technique

JAMA. 1977;237(5):446-447. doi:10.1001/jama.1977.03270320024004

To the Editor.—  Reluctance to perform a venous cutdown or to insert a large (10- or 12-gauge) needle into a vein has delayed the widest possible use of the balloon-tipped Swan-Ganz catheter.1 A percutaneous introduction technique described in 1953 by Seldinger2 circumvents many of these difficulties. It allows the initial venipuncture to be made with a small (18-or 20-gauge) needle. A guide wire is then threaded through that needle, and the wire is used to guide subsequent dilators and the catheter-introduction cannula into the lumen of the vein.The flow of blood from the central venous system through the right heart into the pulmonary artery guides the catheter into place. The catheter tip can be positioned reliably by recognizing the characteristic pressure changes as it passes through the various cardiac chambers.Any vein with a lumen large enough to accommodate the desired catheter is a candidate for catheterization