Insufflation of the Airway
or Needle Cricothyroidotomy
- Only useful if pt has normal pulmonary function and no significant
- Dangerous in context of persistent glottic obstruction as high
pressure may cause barotrauma as well as expelling the foreign body
(low flow 5-7L/minute should be used)
1. Connect O2 tubing to wall
source with free flow, 40-50psi (15L/min).
- cut a hole (to occlude with thumb) in the tubing at the non-wall end.
2. Place patient supine.
3. Assemble a 14g angiocath, the barrel (plunger removed) of a 2ml
syringe and a connector piece from a size 7-8 ET tube
- (remember 2x7=14)
4. Palpate cricothyroid membrane, anteriorly, between thyroid cartilage
and cricoid cartilage.
- stabilise trachea with thumb and forefinger of 1 hand to prevent
lateral movement of trachea.
- prep site.
5. Puncture skin with a 14g needle attached to a syringe over the
- a small incision facilitates needle passage.
- direct the needle 45o caudally while applying negative pressure to
6. Carefully insert needly through lower half of cricothyroid membrane,
aspirating as advances.
- aspiration of air signifies entry into the tracheal lumen.
7. Remove syringe and withdraw stylet advancing catheter into
- don't perforate the back wall of the trachea.
8. Attach the syringe barrel and connector to Oxygen and
- secure it on their neck.
9. Intermittently ventilate by occluding the open hole for 1
second, then releasing for 4 seconds (some exhalation will occur).
- adequate PaO2 can only be maintained for 30-45mins and Co2
accumulation may occur more rapidly.
10. Continue to observe lung inflation and auscultate chest.
11. Prepare for definitive airway.
1. Inadequate ventilation --> hypoxia, death.
2. Aspiration (blood)
3. Oesophageal laceration
5. Posterior tracheal perforation.
6. Subcutaneous emphysema.
7. Thyroid perforation.