NEEDLE CRICOTHYROIDOTOMY ، TRANSTRACHEAL JET INSUFFLATION

This is a technique for achieving oxygenation. It does not provide adequate ventilation. It is the emergency surgical airway of choice in children <12 years old. It can be useful in severe axiomatically trauma, but can also be used in the setting of an upper airway obstruction from any cause

TECHNIQUE

• Inform the patient/parents if possible.
• Local anesthesia using 1% Novocaine with adrenaline. This is infiltrated into the skin overlying the hypothyroid membrane and on to the membrane itself. Aspiration of air will confirm the needle's passage beyond the membrane and into the trachea.
• With a 5 ml syringe attached to the annular and aspirating as you go, advance the annular tip through the inferior part of the hypothyroid membrane aiming caudally.
• When air is aspirated freely, advance 1-2 mm further, stop and slide the annular sheath of the needle while holding the needle still. Remove the needle, leaving the cannula sheath in place.
• Now connect :

                  the 3 way stopcock to the annular

                  the oxygen tubing to the 3 way stop cock

• Commence the oxygen flow at 15 l/min and use the stop cock to control ventilation IE on to the patient on inspiration / off to the patient for expiration.
• Expiatory phase 2 seconds, or until the chest rises.
• Expiratory phase 4 seconds.
• If expiration is incomplete, insert another cannula next to the first to act as a vent.
• The procedure will provide adequate oxygenation for up to 45-60 minutes.

Alternative :

A 2ml syringe can be connected to the cannula after insertion. The plunger is removed from the syringe and the connector from a size 7 ET is inserted in its place. A bag and valve attached to oxygen can then be connected and the patient oxygenated.

COMPLICATIONS

• Mal position

                subcutaneous emphysema

                hemorrhage

• Injury to nearby structures

               vocal cords

               cricked cartilage

               trachea

               carotid arteries

               vague / recurrent laryngeal nerves

               jugular veins

               esophagus

• Bertram

               especially in infants or in patients with complete upper airway obstruction

• Infection

ADVANTAGES

• Less complications than surgical airways
• Easier than other surgical airways
• Requires minimal surgical skills
• Can be used in young children

DISADVANTAGES

• Does not provide a definitive airway
• Does not provide adequate ventilation
• Exposes the lungs to potentially high pressures