Cricothyrotomy Needle

Procedure Guidelines

If unable to ventilate and airway not patent, perform Needle Cricothyrotomy, as listed on line 6, page 2-8 in the Practice Parameters.
Preferred over surgical cricothyrotomy in children under 12 years old.
Preferred over surgical cricothyrotomy in patients with known clotting disorders and/or anticoagulant therapy.

Place the patient in a supine position with the neck in a neutral position.
Gather and prepare equipment.
Prepare site with Antiseptic swabs.
Palpate the cricothyroid membrane, anteriorly, between the thyroid cartilage and cricoid cartilage. Stabilize the trachea with the thumb and forefinger of one hand.
Stretch skin taut.
Puncture the skin midline with the needle attached to the syringe, directly over the cricothyroid membrane.
Direct the needle at a 45 degree angle caudally, while applying negative pressure to the syringe.
Carefully insert the needle through the lower half of the cricothyroid membrane, aspirating as the needle is advanced.
Aspiration of air signifies entry into the tracheal lumen.
Remove the syringe and withdraw the needle while gently advancing the catheter downward into position, being careful not to perforate the posterior wall of the trachea.
Attach 3.0 mm ET adapter to hub of catheter, connect BVM and ventilate while manually stabilizing catheter.
Observe breath sounds and auscultate the chest for adequate ventilation.
Secure the catheter to the patient's neck with tape (chevron) after area prepped with benzoin.
Continue to ventilate and observe chest rise.