teknik yang digunakan untuk mencapai akses arteri adalah dengan teknink Seldinger (It is named after Dr. Sven-Ivar Seldinger (1921-1998), a Swedishradiologist from Mora, Dalarna County, who introduced the procedure in 1953). Steps in the Seldinger technique :
- A needle (biasanya 18 gauge) with stylet is advanced through both walls of the vessel
- The stylet is removed and the needle is withdrawn slowly into the vessels lumen. Pulsatile blood will flow out the back of the needle
- A guidewire is advanced into the vessel using fluoroscopic guidance
- The guidewire is hel in place and the needle is removed over the wire while firmly compressing the puncture site
- A catheter is passed over the wire into the vessel lumen
- The guidewire is removed, leaving the catheter in the vessel ready for injection of contrast media
The area of the groin or arm where the catheter will be inserted is shaved, cleaned, and numbed with local anesthetic. The radiologist will make a small incision (usually a few millimeters) in the skin where the catheter can be inserted into an artery. The catheter is then guided through the arteries to the area to be examined. After the contrast material is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken. Then the catheter is removed and the incision site is closed by placing pressure on the area for approximately 10 to 20 minutes (or by using a special closure device).
Skin entry: A small skin incision is sometimes needed, using a scalpel through which a Seldinger needle is inserted to puncture the femoral artery. The arterial needle is held between the index and the middle fingers of the right hand (as if holding a pencil) with the tip bevel directed upward. The needle is introduced through the skin and advanced slowly toward the artery at a 30 to 45-degree angle to the horizontal plane. Pulsation may be felt when the needle contacts the arterial wall and a slight resistance to the needle can be felt as it passes trough the wall. At this point, the a jet of blood from the needle hub confirms arterial puncture. The J-tipped guidewire is straightened and introduced into the needle with the right hand. The wire should be introduced only when a good pulsatile blood flow is present. Guidewire insertion: the guide wire is advanced gently into the artery and it should move without resistance and the needle is withdrawn, then followed by insertion of a 5F sheath-dilator assembly over the wire while holding the guidewire straight and stable, the operator introduces the sheath-dilator assembly into the artery by firmly holding it close to the tip, making, clockwise and counter-clockwise half-rotations and applying firm advancing pressure.
When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. Your intravenous line will be removed.