NEEDLE CRICOTHYROIDOTOMY

King Saud UniversityCollege of Nursing

Hatem Alsrour

DEFINITION

• Needle Cricothyroidotomy - the introduction of an over-the-needle catheter device into the cricothyroid membrane to provide a temporary airway and oxygenation

OBJECTIVESAt the completion of this lecture the participant will be able to:

• State the indications for needle cricothyroidotomy

• Identify the equipment necessary to perform needle cricothyroidotomy

• Identify the landmarks of the cricothyroid membrane

-Discuss the potential complications of needle cricothyroidotomy

-Successfully perform needle cricothyroidotomy on a manikin

INDICATIONS

• Unconscious patient with a complete airway obstruction unrelieved by all other means appropriate to the situation

• BASE STATION ORDER

CAUSES OF AIRWAY OBSTRUCTION

– foreign body aspiration

– severe facial trauma

– infections

– swelling of the airway

– external swelling from injury

CONTRAINDICATIONS

• Patient weighing less than 40 kg

• Unable to identify landmarks

CRICOTHYROID MEMBRANE

• Is located between the thyroid and cricoid cartilage on the anterior neck

Cricothyroid Membrane

SURROUNDING STRUCTURES

• Thyroid cartilage

• Thyroid gland

• Parathyroid glands

LANDMARKSLocate the superior aspect of the thyroid cartilage (prominence on the anterior neck)

Follow down midline to the indentation of the cricothyroid membrane

• The carotid arteries and jugular veins

• Additional blood vessels that feed into the thyroid gland

COMPLICATIONS• Penetration of adjacent structures

(esophagus)

• Subcutaneous emphysema• Swelling• Severe bleeding• Damage to the larynx• Injury to the thyroid and parathyroid

glands

EQUIPMENT

• Personal protective equipment

• Emergency Transtracheal Airway Catheter

• ENK Flow Modulator

• 10 cc syringe

• Alcohol prep

• 02 tank capable of delivering 30-60 psi

• Cloth or silk tape

EQUIPMENT (con’t)

• Emergency Transtracheal Airway Catheter– The ribbing on the

catheter keeps it from collapsing or kinking

• ENK Flow Modulator and pressure adapter

• Connect to 15 L of 02 (1)

(1)

(2)

(3)• Covering and

uncovering the holes allows for oxygen movement in and out of the lungs (2)

• Medication can be administered through the port into the trachea (3)

• The needle and modulator will come prepackaged

• Needle cricothyrotomy is recommended when unable

• to oxygenate/ventilate children < 12 years of age

PROCEDURE

• Once your equipment is assembled, position the patient’s head

• If trauma - maintain the head in neutral position

• If no trauma- extend the neck

• Identify the superior aspect of the thyroid cartilage– prominence,

midline, anterior neck

• Follow midline down to the soft cricothyroid membrane (approximately 1 cm)

• Cleanse the site with an alcohol prep

• Stabilize the larynx by holding the cartilage between your fingers

• Direct the needle at a 90o angle to the patient

• Slowly advance the needle 1/2” - 3/4” with plastic catheter

• Attempt to aspirate free air as you advance

• Once you have aspirated free air, direct the needle toward the sternal notch

• Remove the needle

• Attach the catheter to the ENK Flow Modulator

• DO NOT LET GO OF THE CATHETER

• Assess the patient’s ABCs– do not expect to see significant rise and fall

of the chest wall

– if the patient begins spontaneous breathing, time your oxygenation with inhalation

– monitor patient’s color and heart rate

– if available, pulse oximeter may be helpful

– don’t forget COMPRESSIONS, if pulse is absent