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

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
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 remain open for TV
      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
6. Attach 7-0 ETT adapter to syringe
7. Attach BVM to ETT adapter
8. Secure system
9. Ventilate with BVM or high flow O2 setup
10. OBTAIN DEFINITIVE AIRWAY

Complications

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

Source

Roberts and Hedges

1. 1. Very rigid system, may dislodge with small movements
2. Ventilate