Needle Cricothyroidotomy 2 - Hatem Alsrour

King Saud University College of Nursing

NEEDLE CRICOTHYROIDOTOMY 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

OBJECTIVES At 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

LANDMARKS Locate 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) • 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)

(3) (2)

(1)

• 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 traumaextend 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