Cricothyrotomy, Assisting
When endotracheal intubation or a tracheotomy can’t be performed quickly to establish an airway, an emergency cricothyrotomy may be necessary. Performed rarely, this procedure involves puncturing the trachea through the cricothyroid membrane.
Usually, your role will be to assist a doctor with this procedure, but if you have received special training, you may have to perform the procedure in an emergency. Ideally, cricothyrotomy is performed using sterile technique but, in an emergency, this may not be possible.
Equipment
Have one person stay with the patient while another collects the necessary equipment.
For Scalpel or Needle Cricothyrotomy
Sterile gloves ▪ goggles ▪ antiseptic cleaning solution ▪ sterile 4″ × 4″ gauze pads ▪ sterile drapes or towels ▪ dilator ▪ tape ▪ oxygen source.
For Scalpel Cricothyrotomy
Scalpel ▪ #6 or smaller tracheostomy tube (if available) ▪ handheld resuscitation bag or T tube and wide-bore oxygen tubing.
For Needle Cricothyrotomy
14G (or larger) through-the-needle or over-the-needle catheter ▪ 10-mL syringe ▪ tape ▪ IV extension tubing ▪ hand-operated release valve or pressure-regulating adjustment valve.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.1
Place the patient in the supine position.
Hyperextend the patient’s neck to expose the area of the incision site.
The doctor cleans the patient’s neck with a gauze pad soaked in antiseptic cleaning solution. To reduce the risk of contamination, he should use a circular motion, working outward from the incision site.
Assist with draping the patient’s neck with sterile towels.
The doctor locates the precise insertion site by sliding his thumb and fingers down to the thyroid gland. He’ll know he’s located its outer borders when the space between his fingers and thumb widens.
The doctor assesses for hematomas, which may displace the trachea to the unaffected side.
The doctor then moves his fingers across the center of the gland, over the anterior edge of the cricoid ring (as shown below).
 |
Using A Scalpel
Hand the doctor a scalpel so he can make a horizontal incision, less than ½″ (1.3 cm) long, in the cricothyroid membrane just above the cricoid ring.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
