Syringeless CVC Placement

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.

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

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...

Air embolus not a worry?

Easy to do the same technique, leave syringe ON the angiocath, enter vessel, take needle out, put syringe back on angio, wire through syringe. Cleaner and safer to me. Confirm placement same with wire in vessel before dilation.

From experience...that wire isn't going anywhere. There is no reason to insert the wire so that the terminal end is anywhere near the end of the needle hub. I generally have at least 10cm remaining outside the patient and have never seen any propensity for the wire to get spontaneously sucked into the patient. Granted, the distal end has a curl in it which provides for some increased surface area inside the IJ/SVC/RA but the flow rate in those areas does not seem to be enough to move the wire. I think that the "don't let go of the wire" dogma comes from the next step...inserting the "central line catheter". If one simply places the wire inside the tip of the catheter and then inserts it this will obviously result in a wire in the central venous circulation. The method requires feeding the wire until it exits the proximal end of the catheter. At this point it is wise to hold the wire in one hand and feed the catheter with the other.