Pediatric Needle Cricothyroidotomy

Pediatric Needle Cricothyroidotomy 

Supplies

• (Kit located in 2^nd 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

1. Identify landmarks and stabilize the larynx with non-dominant hand
2. Access the cricothyroidotomy membrane with a 16G angiocath, aim in the caudad direction
3. Connect syringe with saline and pull-back to confirm placement by air aspiration
4. If placement is confirmed, connect macrobore tubing to catheter and then place 3.0 ETT end on tubing (See picture).
5. Connect to a pressure limiting bag or a jet ventilation device
6. Breaths should be delivered over 1 second and allowing for 2 second exhalation
7. 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.