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B)
PERCUTANEOUS
TRANSTRACHEAL NEEDLE VENTILATION
1) INDICATIONS
a)
Severe neck and facial trauma
b)
Intraoral trauma
c)
Subglottic stenosis
d)
Laryngeal fracture
e)
Facial/oral anatomical abnormalities
f)
Failed endotracheal intubation
2) TECHNIQUE
a)
Intermittent jets of oxygen under high pressure (50 psi)
b)
14-16 gauge cannula will flow 400-500 cc/second
c)
Locate cricothyroid membrane
d)
Insert 14 gauge 8.5 cm long catheter at a 45 degree caudad into trachea and
withdraw on syringe. Check placement by aspirating air into the syringe.
e)
Ventilate at a rate of 12/minute with an inspiration phase of 1 to 1.5 seconds
Figure 1-13.
Translaryngeal catheter ventilation. (From Clinton.)
3) COMPLICATIONS
a)
Hemorrhage
b)
Esophageal perforation
c)
Subcutaneous and mediastinal emphysema
d)
Introduction of foreign matter into respiratory tree
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