CRICOTHYROIDOTOMY

Needle  procedure:

1. Prepare 14 gauge catheter-over-needle (angiocath), 3 mm pediatric endotracheal tube adapter, oxygen  tubing and high flow oxygen.
    
2. Palpate the cricothyroid membrane (located between the caudal end of thyroid cartilage and 1st tracheal ring).
    
3. Prep with iodine (Betadine). With the 14 gauge catheter-over-needle on the syringe, advance needle through the  membrane at a 45 degree angle directed caudaly.
    
4. Advance the catheter.
    
5. Remove the needle, then attach hub to a 3 mm endotracheal tube adapter connected to oxygen tubing.
    
6. Administer O2 at 15 liters per minute for 1-2 seconds on, then 4 seconds off; control air flow by using a hole in the side of the tubing.
    
7. Use needle cricothyrotomy for no more than 45 minutes, since exhalation of C02 is inadequate.       

Surgical  procedure:

1. Prep the area with iodine (Betadine). Prepare cut-down tray.
    
2. Palpate the cricothyroid membrane (located between thyroid cartilage and first tracheal ring). Hold firmly between two fingers.
    
3. Make a vertical  skin incision.
    
4. Incise the membrane horizontally.
    
5. Insert the knife handle, and rotate 90 degrees to open the hole, or use a hemostat to dilate.
    
6. Insert a small (5-7 mm) tracheostomy tube.
    
7. Inflate the balloon. Ventilate.

[BACK]