Cricothyrotomy Needle

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:

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

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

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Remove needle from catheter.

Gently advance catheter downward into position.