Jet Insufflation of the Airway
or Needle Cricothyroidotomy

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Caution
- Only useful if pt has normal pulmonary function and no significant chest injury.
- 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 cricothyroid membrane
- a small incision facilitates needle passage.
- direct the needle 45o caudally while applying negative pressure to the syringe.

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 patients neck.
- don't perforate the back wall of the trachea.

8.  Attach the syringe barrel and connector to Oxygen and angiocath.
- 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.

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Complications

1.  Inadequate ventilation --> hypoxia, death.
2.  Aspiration (blood)
3.  Oesophageal laceration
4.  Haematoma.
5.  Posterior tracheal perforation.
6.  Subcutaneous emphysema.
7.  Thyroid perforation.

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