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Needle Cricothyrotomy

Clinical Indications:

    Failed Airway Protocol
    Management of an airway when standard airway procedures cannot be accomplished or have failed in a patient less than 12 years of age.


    1. Have suction supplies available and ready.
    2. Locate the cricothyroid membrane utilizing anatomical landmarks.
    3. Use the non-dominant hand to secure the membrane.
    4. Prep the area with antiseptic swab (Betadine).
    5. Draw up 2 ½ cc of Normal Saline with a 5 cc syringe and attach the needle supplied in the needle cricothyrotomy kit. (5-cc syringe attached to a 14 gauge catheter-over-needle device), insert the needle through the cricothyroid membrane at a 15 degree caudal angle (toward the feet).
    6. Aspirate for air with the syringe throughout the procedure.
    7. Once air bubbles returns easily, stop advancing the device.
    8. Attach a 15 mm adapter (from a 3.0 tube) to the needle hub. Ventillate with highest O2 concentration using BVM.
    9. Assess breath sounds. Make certain ample time is used not only for inspiration butexpiration as well.
    10. Secure needle by best method available, recognizing that this method may be direct hands-on control of the device throughout the entire transport.
    11. If unable to obtain an adequate airway, resume basic airway management and transport the patient as soon as possible.
    12. Document time/procedure/confirmation/change in patient condition/time on the patient care record (PCR).

Certification Requirements:

    Successfully complete an annual skill evaluation inclusive of the indications, contraindications, technique, and possible complications of the procedure.

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