What is the modern Seldinger technique?

September 23, 2025 •

4 min read

Originally developed in 1953, the Seldinger technique represents a pivotal advancement in minimally invasive procedures, reducing patient risk and discomfort. The modern Seldinger technique incorporates key refinements and tools, such as ultrasound guidance, to further increase accuracy and safety for vascular access.

Quick Summary

The modern Seldinger technique is a minimally invasive medical procedure for inserting catheters into a vessel, refined with modern tools like ultrasound guidance to enhance safety and accuracy compared to the original method.

Key Points

Refined Technique: The modern Seldinger technique is an updated version of the classic procedure, incorporating advanced tools to improve safety and efficacy.
Ultrasound Guidance: A key modern enhancement is the use of real-time ultrasound, which allows clinicians to visualize the target vessel, minimizing procedural risks.
Modified and Micro-Variations: The Modified Seldinger Technique (MST) and Micro-Seldinger Technique (MST) use smaller sheaths and finer needles, respectively, to reduce vessel trauma, especially for delicate or small vessels.
Minimally Invasive: The technique provides percutaneous access for catheter insertion, replacing more invasive surgical methods for many procedures.
Wide Application: It is the standard approach for numerous medical interventions, including placing central lines, PICCs, and performing procedures in interventional radiology.
Increased Safety: Modern advancements have dramatically reduced complications such as hematoma, arterial puncture, and infection risks compared to the original landmark-based method.

The Foundations of the Seldinger Technique

The Seldinger technique was invented by Swedish radiologist Sven Ivar Seldinger in 1953, revolutionizing how doctors accessed blood vessels and other hollow organs. Before this innovation, achieving vascular access often required invasive surgical cutdowns, which carried greater risks and caused more patient discomfort. The genius of Seldinger's method was its elegant simplicity: using a guidewire as a temporary pathway to insert a catheter, eliminating the need for a large-bore needle or extensive surgical exposure. This foundational principle remains central to the procedure today, though the tools and associated methods have seen significant improvements.

The Core Steps of the Classic Technique

The original method follows a clear sequence:

Vessel Puncture: A hollow needle is used to puncture the target vessel, such as an artery or vein.
Guidewire Insertion: A flexible, round-tipped guidewire is advanced through the needle's lumen into the vessel.
Needle Removal: The rigid needle is withdrawn over the guidewire, leaving the guidewire in place.
Catheter Insertion: A catheter or sheath is threaded over the stationary guidewire and into the vessel.
Guidewire Removal: The guidewire is removed, leaving the catheter secured in the correct position.

Advancements Defining the Modern Seldinger Technique

While the basic principle is the same, modern practice has evolved with significant advancements that have made the procedure even safer and more effective. These updates are so common they are now considered standard practice, defining the 'modern' approach.

Ultrasound Guidance

Perhaps the most significant modern advancement is the routine use of ultrasound guidance. Instead of relying on anatomical landmarks, which can vary between patients, clinicians can now visualize the vessel in real-time. This reduces the number of attempts needed to access the vein or artery, significantly lowering the risk of complications like accidental arterial puncture, hematoma formation, and nerve damage.

The Modified Seldinger Technique (MST)

The Modified Seldinger Technique (MST) is another crucial evolution, particularly for placing smaller catheters or in challenging vascular access situations, such as in pediatric patients. In this variation, a needle is used to puncture the vessel, but a small cannula or sheath is advanced over the needle, and the needle is then removed. The guidewire is then inserted through this small, flexible sheath, which can be less traumatic to the vessel wall. Studies have shown the MST can result in higher first-attempt success rates in certain patient populations, like neonates.

Micro-Seldinger Technique

A further refinement is the Micro-Seldinger Technique (MST), which utilizes even smaller needles and guidewires. This is particularly beneficial for delicate vessels and further minimizes the risk of vessel damage and bleeding.

Comparison: Classic vs. Modern Seldinger Technique


Feature	Classic Seldinger Technique	Modern Seldinger Technique (with MST)
Vessel Puncture	With a hollow, relatively large-bore needle.	Often with a smaller, finer needle and an attached sheath (MST).
Access Guidance	Primarily based on anatomical landmarks.	Almost universally guided by real-time ultrasound imaging.
Insertion Path	The guidewire passes directly through the initial puncture needle.	In MST, the guidewire passes through a small, flexible catheter/sheath introduced via the needle.
Safety	Relies on anatomical knowledge, with higher risk of complications.	Enhanced safety with visual confirmation, reducing risks like vessel perforation and hematoma.
Application	Still used, but often supplanted by modern variations for certain procedures.	The standard of care, used for a wide range of procedures including central venous access, PICC lines, and interventional radiology.

Common Applications in Modern Medicine

The modernized Seldinger approach is fundamental to a vast array of medical specialties and procedures. Its minimally invasive nature makes it the preferred method for many interventions.

Central Venous Catheterization: Placing central lines in large veins for long-term medication delivery, fluid administration, or hemodialysis.
Arterial Catheterization: Inserting catheters into arteries for continuous blood pressure monitoring or blood sampling in critical care settings.
Peripherally Inserted Central Catheters (PICC): Placing long-term IV lines through a peripheral vein that extends to a central one.
Interventional Radiology: Essential for a wide range of diagnostic and therapeutic procedures, including angiography, embolization, and angioplasty.
Percutaneous Drainage: Inserting drainage catheters into fluid collections within the body, such as abscesses.
Pacemaker/Defibrillator Lead Placement: Used to guide the leads for these devices into the heart.

For a deeper dive into the history and significance of the original invention, see the comprehensive article on the National Institutes of Health website.

The Evolution of Patient Comfort and Safety

The modern Seldinger technique has profoundly impacted patient care by shifting procedures from open surgical interventions to less traumatic, percutaneous approaches. The integration of ultrasound has led to fewer failed attempts and fewer complications, directly translating to better patient outcomes and faster recovery times. The use of smaller, more advanced equipment in variations like the Micro-Seldinger further refines this approach, making it possible to access even very small or fragile vessels with high precision. This continuous evolution underscores the technique's status as a cornerstone of modern interventional medicine.

Considerations and Risks

While highly safe, the modern Seldinger technique still carries some risks, including bleeding, infection, and potential damage to the surrounding structures. However, modern tools and protocols, including ultrasound guidance and advanced imaging, have drastically reduced these risks compared to earlier practices. Careful adherence to sterile technique and procedural protocols remains paramount for ensuring patient safety.

Conclusion: An Enduring Legacy

The modern Seldinger technique is a prime example of a foundational medical innovation that has continually adapted and improved over decades. By incorporating technologies like ultrasound and evolving into micro-versions, the technique remains a vital, safe, and efficient method for vascular and organ access across multiple medical disciplines. Its legacy is not just in its original brilliance, but in its enduring adaptability that has allowed it to define the standard of care for minimally invasive procedures today.

Frequently Asked Questions

The original Seldinger technique was invented by Swedish radiologist Sven Ivar Seldinger in 1953, revolutionizing minimally invasive vascular access procedures.

Ultrasound improves the modern Seldinger technique by providing real-time visualization of the blood vessel and surrounding anatomy. This allows the clinician to guide the needle with greater precision, reducing the number of attempts and lowering the risk of complications like vessel damage or accidental arterial puncture.

The main difference lies in the order of insertion. In the classic Seldinger, the guidewire goes directly through the needle. In the Modified Seldinger (MST), a small sheath is advanced over the needle, the needle is removed, and then the guidewire is inserted through the sheath, which can be less traumatic to the vessel.

The modern Seldinger technique is used for placing central venous catheters, peripherally inserted central catheters (PICC lines), arterial lines, and for a wide range of procedures in interventional radiology, such as angiography and angioplasty.

Yes, the Seldinger technique is very much still in use today. The modern version, often incorporating ultrasound guidance and modified versions, is a fundamental technique taught and used extensively across numerous medical specialties for safe vascular access.

While modern techniques have reduced risks, potential complications include bleeding, hematoma (bruising), infection at the puncture site, and, rarely, damage to the vessel or surrounding structures. Proper sterile technique and the use of ultrasound minimize these risks.

Patients are typically given a local anesthetic to numb the area before the needle is inserted. While some pressure or minor discomfort may be felt, the process is generally well-tolerated, and the minimally invasive nature reduces post-procedural pain.