Objective Micro-introducers for insertion of a peripherally inserted central venous catheter (PICC) using the “Seldinger technique” are only available for catheters of at least 4-french diameter. Here we describe a modified “Seldinger technique” for insertion of 2-french micro-introducers.
Methods We combined a 2-french peripheral arterial catheter suitable for Seldinger technique with the micro-introducer of a 2-french PICC. Therefore the arterial catheter was put into the micro-introducer instead of the steel needle (A). Thus, a device similar to that used in heart catherisation was created with the micro-introducer serving as sheath and the arterial catheter as dilator. After puncture of a peripheral vein with a peripheral venous catheter (22-G) the Seldinger wire guide of the arterial catheter was inserted (B). Consecutively the peripheral venous catheter was removed and the combined device (micro-introducer carrying the arterial catheter inside) was pushed forward over the wire guide into the peripheral vein (C). Thereafter, the Seldinger wire guide and the peripheral arterial catheter were removed and the PICC was safely inserted through the micro-introducer (D).
Results With this method 14 out of a total of 16 2-french catheters could be inserted safely into peripheral veins of patients aged between one day and seven years.
Conclusions With this modified “Seldinger technique” 2-french central venous catheters can be safely placed into peripheral veins. Thus successful insertion of a small peripheral venous catheter offers a possibility for the insertion of a central venous line.