Needle cricothyrotomy

Indications

1. Failed airway in adults or children
2. Temporizing measure until definitive airway management
   1. Especially useful in children <8 yrs old, whom cricothyrotomy contraindicated
3. Used for transtracheal jet ventilation
4. Foreign Body in upper airway

Contraindications

1. Tracheal transection
2. Complete upper airway obstruction

Equipment

1. Provodone iodine
2. Sterile drapes, gloves, gown, gauze
3. 12-14 G angiocath
4. 3mL syringe x 2
5. Adapter to 7-0 ETT or adapter to 3-0 ETT
6. BVM appropriate for size of pt
   1. Can also use jet vet ventilation setup in adults
      1. High flow O2 source, 50 PSI
      2. O2 tubing
      3. Valve-3 way stop cock or cut holes in O2 tubing
      4. Depending on O2 source, calculate time valve must be open for tidal vol
      5. BVM setup does not allow adequate exhalation in adults

Procedure

1. Prep and drape
2. Locate cricothyroid membrane
3. Pierce membrane with angiocath directed 30-45 deg caudal
   1. Attach 3mL syringe with saline, aspirate as you enter
   2. Advance until air is aspirated in syringe
4. Advance catheter over needle, hub to skin
   1. Remove needle
5. Attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
   1. Or can attach 3-0 ETT adapter directly to angiocath
6. Attach BVM to ETT adapter
7. Secure system
8. Ventilate with BVM or high flow O2 setup
9. OBTAIN DEFINITIVE AIRWAY
   1. Should be used for < 45 minutes

Complications

1. Hemorrhage
2. Infection
3. Tracheal stenosis
4. Not obtaining definitive airway management

See Also

Intubation

Cricothyrotomy

Source

Roberts and Hedges