9.09 CRICOTHYROTOMY (NEEDLE)
- 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.
- 14 gauge over the needle catheter.
- 3.0 mm endotracheal tube adapter 12 ml syringe.
- Antiseptic swabs.
- 12 cc syringe.
- Occlusive dressing.
- 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.
Palpate the cricothyroid membrane, anteriorly, between the thyroid cartilage and cricoid cartilage.
Puncture the skin directing the needle at a 45-degree angle caudally.
Remove needle from catheter.
Gently advance catheter downward into position.