Needle cricothyrotomy: Difference between revisions
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== Indications== | ==Indications== | ||
*Failed airway in adults or children | *Failed airway in adults or children | ||
**Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source<ref name=Roberts and Hedges' Clinical Procedures in Emergency Medicine>In Roberts, J. R., In Custalow, C. B., In Thomsen, T. W., & In Hedges, J. R. (2014). Roberts and Hedges' clinical procedures in emergency medicine.</ref>) | **Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source<ref name=Roberts and Hedges' Clinical Procedures in Emergency Medicine>In Roberts, J. R., In Custalow, C. B., In Thomsen, T. W., & In Hedges, J. R. (2014). Roberts and Hedges' clinical procedures in emergency medicine.</ref>) | ||
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*Obstruction above the level of the cricothryoid membrane | *Obstruction above the level of the cricothryoid membrane | ||
== Contraindications== | ==Contraindications== | ||
When used as a rescue airway, no absolute contraindications. | When used as a rescue airway, no absolute contraindications. | ||
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**Underlying tumor, abscess/infection, or other known abnormality | **Underlying tumor, abscess/infection, or other known abnormality | ||
== Equipment== | ==Equipment== | ||
*Provodone iodine | *Provodone iodine | ||
*Sterile drapes, gloves, gown, gauze | *Sterile drapes, gloves, gown, gauze | ||
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***BVM setup does not allow adequate exhalation in adults | ***BVM setup does not allow adequate exhalation in adults | ||
== Procedure== | ==Procedure== | ||
#Prep and drape | #Prep and drape | ||
#Locate cricothyroid membrane | #Locate cricothyroid membrane | ||
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#*Should be used for < 45 minutes | #*Should be used for < 45 minutes | ||
== Complications== | ==Complications== | ||
*Hemorrhage | *Hemorrhage | ||
*Infection | *Infection | ||
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*Posterior tracheal perforation | *Posterior tracheal perforation | ||
== See Also== | ==See Also== | ||
*[[Intubation]] | *[[Intubation]] | ||
*[[Surgical cricothyrotomy]] | *[[Surgical cricothyrotomy]] | ||
== References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 02:36, 7 July 2016
Indications
- Failed airway in adults or children
- Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on sourceCite error: Invalid
<ref>tag; invalid names, e.g. too many)
- Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on sourceCite error: Invalid
- Temporizing measure until definitive airway management
- Obstruction above the level of the cricothryoid membrane
Contraindications
When used as a rescue airway, no absolute contraindications.
- Relative Contraindications
- Inability to identify landmarks
- Tracheal transection or severe trauma
- Underlying tumor, abscess/infection, or other known abnormality
Equipment
- Provodone iodine
- Sterile drapes, gloves, gown, gauze
- 12-14 G angiocath
- 3mL syringe x 2
- Adapter to 7-0 ETT or adapter to 3-0 ETT
- BVM appropriate for size of pt
- Can also use jet vet ventilation setup in adults
- High flow O2 source, 50 PSI
- O2 tubing
- Valve-3 way stop cock or cut holes in O2 tubing
- Depending on O2 source, calculate time valve must be open for tidal vol
- BVM setup does not allow adequate exhalation in adults
- Can also use jet vet ventilation setup in adults
Procedure
- Prep and drape
- Locate cricothyroid membrane
- Pierce membrane with angiocath directed 30-45 deg caudal
- Attach 3mL syringe with saline, aspirate as you enter
- Advance until air is aspirated in syringe
- Advance catheter over needle, hub to skin
- Remove needle
- Attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
- Or can attach 3-0 ETT adapter directly to angiocath
- Attach BVM to ETT adapter
- Secure system
- Ventilate with BVM or high flow O2 setup
- OBTAIN DEFINITIVE AIRWAY
- Should be used for < 45 minutes
Complications
- Hemorrhage
- Infection
- Tracheal stenosis
- Subcutaneous emphysema
- Posterior tracheal perforation