Cricothyrotomy Surgical

Procedure Guidelines 9.10

CRICOTHYROTOMY (SURGICAL)

INDICATIONS:

• If unable to ventilate and airway not patent, perform Cricothyrotomy, as listed on line 5, page 2-7 in the Practice Parameters.
• When an airway is needed and intubation is unsuccessful.

CONTRAINDICATIONS:

• Children under 12 years old.
• Known bleeding disorder and/or anticoagulant therapy.
• Unable to locate landmarks.

EQUIPMENT:

• #11 scalpel blade with handle.
• Needle nose hemostats.
• 5.0 to 7.0 mm endotracheal tube, cut above pilot balloon.
• Antiseptic swabs.
• Tape.
• BVM.

PROCEDURE: (refer to illustrations):

• Place the patient in a supine position with the neck in a neutral position.
• Palpate the thyroid notch, cricothyroid membrane, and the sternal notch for orientation. Gather equipment.
• Prepare site with Antiseptic swabs.
• Stabilize the thyroid cartilage with thumb and 3rd finger of hand. Stretch skin taut.
• Make a superficial transverse skin incision over the cricothyroid membrane. Carefully puncture through the membrane and maintain site with tip of gloved index finger.

• Insert the scalpel handle into the incision and rotate 90 degrees to open airway OR insert hemostats to enlarge opening for passage of tube.
• Insert cuffed endotracheal tube into the cricothyroid membrane incision directing the tube distally into the trachea.
• Inflate the cuff and ventilate the patient with BVM.
• Observe breath sounds and auscultate the chest for adequate ventilation.
• Secure the endotracheal tube.
• Continue to ventilate and observe chest rise.