How do you improvise a cricothyrotomy with only IV supplies? The answer is not a needle cric – it is the “IV Spike Cric.”
This technique, oft cited as military invention, uses a ‘high flow’ IV tubing set either by itself or in conjunction with an ETT to create a cricothyrotomy device that provides for effective ventilation. As with any cricothorotomy, this technique is only a temporizing measure.
Of note, the Baxter Clearlink System high-flow (10 gtt/mL) IV tubing spike and drip chamber have a design particularly favorable for this procedure.
In a cadaveric model, the Baxter brand tubing was determined to be effective; other brands of tubing with different design features have not been specifically tested.
Technique:
1. Cut 7-0 ETT tube at 4cm from BVM connector.
2. Cut IV spike 3-4 cm from spike (in the middle of the drip chamber).
3. Connect the cut ends of the ETT and drip camber (alternatively, the cut end of the IV spike can be used if no ETT is available).
4. The nondominant hand is used to stabilize the trachea and stretch the overlying skin to maximize tension over the cricothyroid membrane and maximize the cutting advantage of the IV spike’s edge.
The cricothyroid membrane should be palpated with the index finger of the dominant hand, and the improvised device is then introduced by puncturing the skin and cricothyroid membrane.
Orientation of the spike perpendicular to the membrane or angled slightly caudally affords the least resistance to tracheal entry.
Once inserted, the device should be held firmly in place at all times and attached to the BVM for immediate ventilation.
5. Stabilize the device with a bulky dressing.
As cricothyrotomy is typically unanticipated and rapid, considerable attention has focused on improvisational approaches. The IV Spike Cric is one such important technique to keep in your airway armamentarium.
-- Eric Beck, DO, EMT-P
References
Platts-Mills TF, Lewin MR, Wells J, Bickler P; Improvised Cricothyrotomy Provides Reliable Airway Access in an Unembalmed Human Cadaver Model. Wilderness and Environmental Medicine, 17, 81-86 (2006).
Blanas N, Fisher JA; Letter to the Editor. Canadian Journal of Anesthesia, 46, 8, 809-810 (1999).
References
Platts-Mills TF, Lewin MR, Wells J, Bickler P; Improvised Cricothyrotomy Provides Reliable Airway Access in an Unembalmed Human Cadaver Model. Wilderness and Environmental Medicine, 17, 81-86 (2006).
Blanas N, Fisher JA; Letter to the Editor. Canadian Journal of Anesthesia, 46, 8, 809-810 (1999).
any chance of a reference for that cadaver model? (it's a research interest of my own)
ReplyDeleteOf course, sorry for the hold up. References are now included
ReplyDeleteVery impressive setup. I wonder how well an inline EtCO2 adapter would work?
ReplyDeleteWhat are the risks of perforation of the posterior tracheal wall, creation of a false passage or early dislodgement? How much force is required to penetrate the skin and fascia and would an initial incision, time allowing, help?
ReplyDeleteThanks
Matthew
intensivecarenetwork.com
I think I saw this on ER once...
ReplyDeleteWhit Fisher has a great video on this as well, http://youtu.be/oIn245TPzAI
ReplyDelete@ Matthew
ReplyDeleteintensivecarenetwork.com
From experience i can say isn`t difficult to create a false passage , u don`t need much strenght to do that , i put one tracheostomy tube from a special kit wich has the same concept , like a needle for guidance . An initial incision could cause a severe bleeding from tiroid vessels. And by the way .. by case , can be usefull a g 16 needle and some oxygen till u get to OR.