Syringeless CVC Placement

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Al Sacchetti demonstrates the use of ultrasound showing the needle tip in the vessel for central venous catheter placement in the internal jugular vein. The wire is then confirmed both in the transverse and longitudinal axis. 

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Jim P. -

I thought we weren’t supposed to let go of the wire lest the wire disappear into the thorax. I had a partner that had that happen and the Pt needed thoracotomy! This video shows the free unsecured wire.

Dallas H. -

The angiocaths in most kits are too soft to be used in fluffier patients because all the soft tissue collapse them.

Tristan J. -

This was the only one that didn't make a ton of sense to me. There didn't seem to be much advantage to NOT having the syringe attached (you can still do exactly this technique with a syringe attached). Conversely, having the syringe attached gives you a easier-to-grip handle on the needle, AND gives you an extra method of confirmation and vessel finding if the direct visualization is proving difficult. What am I missing?

As an aside, in our shop at least we generally in-line ultrasound the wire to verify that it is in the correct vessel before dilating, which serves the same purpose as ultrasounding the softcath here...

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