Cricothyrotomy Needle

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Procedure Guidelines

9.09 CRICOTHYROTOMY (NEEDLE)

INDICATIONS:

  • If unable to ventilate and airway not patent, perform Needle Cricothyrotomy, as listed on line 6, page 2-8 in the Practice Parameters.
  • Preferred over surgical cricothyrotomy in children under 12 years old.
  • Preferred over surgical cricothyrotomy in patients with known clotting disorders and/or anticoagulant therapy.

EQUIPMENT:

  • 14 gauge over the needle catheter.
  • 3.0 mm endotracheal tube adapter 12 ml syringe.
  • Antiseptic swabs.
  • 12 cc syringe.
  • Tape.
  • Occlusive dressing.
  • BVM.

PROCEDURE:

  • Place the patient in a supine position with the neck in a neutral position.
  • Gather and prepare equipment.
  • Prepare site with Antiseptic swabs.
  • Palpate the cricothyroid membrane, anteriorly, between the thyroid cartilage and cricoid cartilage. Stabilize the trachea with the thumb and forefinger of one hand.
  • Stretch skin taut.
  • Puncture the skin midline with the needle attached to the syringe, directly over the cricothyroid membrane.
  • Direct the needle at a 45 degree angle caudally, while applying negative pressure to the syringe.
  • Carefully insert the needle through the lower half of the cricothyroid membrane, aspirating as the needle is advanced.
  • Aspiration of air signifies entry into the tracheal lumen.
  • Remove the syringe and withdraw the needle while gently advancing the catheter downward into position, being careful not to perforate the posterior wall of the trachea.
  • Attach 3.0 mm ET adapter to hub of catheter, connect BVM and ventilate while manually stabilizing catheter.
  • Observe breath sounds and auscultate the chest for adequate ventilation.
  • Secure the catheter to the patient's neck with tape (chevron) after area prepped with benzoin.
  • Continue to ventilate and observe chest rise.

ILLUSTRATION:

Needle Crich 1.jpg


Palpate the cricothyroid membrane, anteriorly, between the thyroid cartilage and cricoid cartilage.


Needle Crich 2.jpg


Puncture the skin directing the needle at a 45-degree angle caudally.

Needle Crich 3.jpg


Remove needle from catheter.

Needle Crich 4.jpg


Gently advance catheter downward into position.