# Needle Cricothyroidotomy

## Overview

This module describes how to perform a needle cricothyroidotomy for oxygenation. This procedure is an interim life-saving technique and must be replaced with a more definitive strategy, such as surgical cricothyroidotomy, tracheostomy or endotracheal intubation, as soon as possible.

## Indications

## Contraindications

## Patient information and consent

This procedure is usually done as an emergency measure with an unconscious patient. However, it may be explained to family members afterwards.

### How do I explain this procedure?

“The patient was unable to breathe because their airway was blocked and air was not getting into their lungs. I had to put a thin tube below the blockage through the skin of their neck into their windpipe so that I could deliver oxygen. This is a temporary measure.”

## Preparation

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### Documentation

### Equipment

Asepsis: do not delay the procedure unnecessarily

## Procedure

## Site & Positioning

Place the patient in a supine position with in-line immobilization of the neck, and hyperextend the neck by placing a 1L IV fluid bag behind the shoulders. Stand at the head, facing caudally.

Identify the landmarks of the cricothyroid membrane. The Adam's apple is the thyroid prominence formed by the thyroid notch. Moving inferiorly, the next solid prominence is the cricoid cartilage. Immediately above the cricoid cartilage the finger slips into the depression of the cricothyroid membrane.

## Procedure

Follow medical asepsis as far as possible. Since this is an emergency procedure, non-sterile gloves and an alcohol swab may be the only aseptic preparations available.

## Troubleshooting

There is significant resistance to ventilation.

Do not expect to see chest rise reliably. The small bore of the catheter provides more resistance to ventilation than you may be accustomed to. Check that the catheter is not kinked or dislodged. If you are unable to oxygenate the patient, consider converting to a surgical cricothyrotomy.

Surgical emphysema or growing mass around cannula insertion site.

You are probably not in the trachea and are insufflating air into the surrounding tissues. Surgical emphysema feels like small cracking pockets of air when you touch the skin. Remove the cannula & re-attempt insertion, and prepare for a more definitive airway such as a surgical cricothyroidotomy.

I don’t have a size 3 or 7.5 ETT.

Fit a 10 ml syringe (plunger removed) to the cannula, insert a cuffed ETT tube into the barrel of the syringe and inflate the cuff.

## Risks

## References