# 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](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://www.paediatricemergencies.com/intubationcourse/course-manual/cricothyroidotomy/)
- [https://medicine.uiowa.edu/iowaprotocols/needle-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.*