Cricothyrotomy Surgical

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Procedure Guidelines 9.10

CRICOTHYROTOMY (SURGICAL)

INDICATIONS:

  • If unable to ventilate and airway not patent, perform Cricothyrotomy, as listed on line 5, page 2-7 in the Practice Parameters.
  • When an airway is needed and intubation is unsuccessful.


CONTRAINDICATIONS:

  • Children under 12 years old.
  • Known bleeding disorder and/or anticoagulant therapy.
  • Unable to locate landmarks.


EQUIPMENT:

  • #11 scalpel blade with handle.
  • Needle nose hemostats.
  • 5.0 to 7.0 mm endotracheal tube, cut above pilot balloon.
  • Antiseptic swabs.
  • Tape.
  • BVM.


PROCEDURE: (refer to illustrations):

SurgCrich1.jpg
  • Place the patient in a supine position with the neck in a neutral position.
  • Palpate the thyroid notch, cricothyroid membrane, and the sternal notch for orientation. Gather equipment.
  • Prepare site with Antiseptic swabs.
  • Stabilize the thyroid cartilage with thumb and 3rd finger of hand. Stretch skin taut.
  • Make a superficial transverse skin incision over the cricothyroid membrane. Carefully puncture through the membrane and maintain site with tip of gloved index finger.
SurgCrich2.jpg
  • Insert the scalpel handle into the incision and rotate 90 degrees to open airway OR insert hemostats to enlarge opening for passage of tube.
  • Insert cuffed endotracheal tube into the cricothyroid membrane incision directing the tube distally into the trachea.
  • Inflate the cuff and ventilate the patient with BVM.
  • Observe breath sounds and auscultate the chest for adequate ventilation.
  • Secure the endotracheal tube.
  • Continue to ventilate and observe chest rise.