Pediatric Needle Cricothyroidotomy
Pediatric Needle Cricothyroidotomy
Supplies
- (Kit located in 2nd Drawer of Pediatric Grey Trauma Cart—Trauma Bay 2)
- 16G Angiocath (IV catheter)
- Macrobore IV Extension Tubing
- End of a 3.0 ETT
- 10 ml Syringe with 5ml saline (for air placement confirmation)
Process for Cannot Intubate and Cannot Ventilate (CICV) Emergency
Video available here: https://youtu.be/EEqXqiOyKr4?si=iF8VRp-n3FwuVeIB
- Identify landmarks and stabilize the larynx with non-dominant hand
- Access the cricothyroidotomy membrane with a 16G angiocath, aim in the caudad direction
- Connect syringe with saline and pull-back to confirm placement by air aspiration
- If placement is confirmed, connect macrobore tubing to catheter and then place 3.0 ETT end on tubing (See picture).
- Connect to a pressure limiting bag or a jet ventilation device
- Breaths should be delivered over 1 second and allowing for 2 second exhalation
- Observe for complications such as: subcutaneous emphysema, hemorrhage, hypoventilation, equipment failure, catheter kink, & false placement.
Additional Resources:
- https://www.paediatricemergencies.com/intubationcourse/course-manual/cricothyroidotomy/
- https://medicine.uiowa.edu/iowaprotocols/needle-cricothyroidotomy
Please contact Dr. Emily Cantrell, Pediatric Trauma Medical Director, or Lora Hofstetter, Pediatric Trauma Program Coordinator for questions and additional training.