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HWN Suggests

Needle Cric

Attach a 10 ml syringe to the hub of the needle. The syringe should contain 3-5 ml of saline. Stand at the head of the bed and aim the needle slightly caudad at an angle of about 30-40 degrees. Aspirate as you advance. Your insertion should be slow and deliberate to avoid puncture of the posterior tracheal wall. The diameter of the adult trachea averages 18 mm. As soon as you enter the tracheal lumen you will see bubbles in the saline as you aspirate air, verifying intratracheal placement.

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  Needle Cricothyroidotomy and Transtracheal Catheter Ventilation

Preferred over surgical cricothyroidotomy in children <10-12 years of age

 Practical Plan for a Needle Cric!

When a pediatric patient needs an emergency needle cricothyrotomy, it is not a time to learn your equipment. You need an angiocath that you can connect a syringe while the needle is still in place. You also need some way to connect an oxygen delivery device to this angiocath. Instead of rummaging through equipment trying to find all of the necessary items, just grab these 3 itmes. 1. A 7.0 ETT 2. A central line kit 3. A Bag-Valve device

Articles of Interest

Can't intubate, Can't Oxygenate

If you look after adults as well as children you should be familiar with the scalpel-finger-bougie technique so I won’t go into the details. The 4th National Audit Project from the Royal College of Anaesthetists in the UK suggested that a scalpel technique was preferable to the alternatives unless practitioners were more experienced in alternative techniques. Failure to commit to a ‘surgical’ airway in a timely fashion was highlighted as a key issue.

Cannula cricothyroidotomy

the 14G Insyte Cannula is preferred for cannula cricotyhroidotomy as it is wide bore, kink-resistant and has memory (regains shape following deformation).

Cricothyrotomy Part 3: Pediatric Points

Child < 10-12 years old, cannot intubate, cannot ventilate, and rescue airway devices not working? Perform percutaneous needle cricothyrotomy (see below). < 5 years old? Bag ventilate. > 5 years old? Jet ventilate.

Don’t Be afraid To Use Percutaneous Jet Ventilation In An Emergency

Needle cricothyrotomy or percutaneous transtracheal jet ventilation (PCJV) can truly be a life saving procedure. It is a fast, effective way of providing oxygen to a patient with an obstructed airway who does not respond to more conventional means of opening the airway. The “can’t intubate-can’t ventilate” scenario is a good example.

Needle cricothyroidotomy with percutaneous transtracheal ventilation (PTV): Procedure summary and clinical tips

Begin regular ventilation with I:E ratio 1:4 and respiratory rate 10 to 12 breaths/min in the patient without complete upper airway obstruction; in patients with complete airway obstruction: I:E ratio 1:8 to 1:10 respiratory rate 5 to 6 breaths/min).

Needle Cricothyrotomy

The attached videos will take you through the procedure of percutaneous needle airway management. The videos will also describe our kit in detail. The kit is “home-made” by us and includes many component parts. Pay specific attention to when to use what combination of materials and to age specific flow rates.

Resources

Entsho.com

Endotracheal intubation is first line for securing the airway. In a 'cannot intubate, cannot ventilate' (CICV) situation, cricothyroidotomy can buy time (minutes) while expert help or definitive treatment is organised. The aim is to insert the largest diameter tube in the least amount of time with the fewest complications.

WikEM

12-14 G angiocath. 3mL syringe x 2. Adapter to 7-0 ETT or adapter to 3-0 ETT.