- It can be performed with the patients head in neutral position.
- Palpate the cricothyroid membrane in the midline, between the thyroid and cricoid cartilages.
- It is critical to stay precisely in the midline during this procedure to ensure the airway is cannulated appropriately and significant bleeding is avoided.
- Attach a 14 gauge angicath to a 10 ml syringe
- While palpating the cricothyroid membrane, insert the angio just below the midpoint of the cricothyroid membrane with the needle angled 45 degrees caudally
- Rapid aspiration of air into the syringe indicates entry into the tracheal lumen.
- Withdraw the needle carefully while advancing the plastic catheter into the trachea, taking care not to perforate the posterior wall.
- Attach the hub of the catheter to an adapter and then to a Y connector which is hooked up to the oxygen supply.
- Oxygen flow is set at 15 liters/minute.
- Intermittent ventilation is achieved by occluding the open port of the Y connecter 1 second vs 4 seconds off.
- This allows about 30-40 minutes of oxygenation
Needle Cricothyroidotomy. A: Anatomy of cricothyroid area. B: Insertion of a angiocatheter. C: Attach Luer-lock to oxygen source. D: Surgical cricothyroidotomy (very rarely indicated).
Source: Advanced Pediatric Life Support Course Text Book