| Mr. Ibrahem/Percutaneous translaryngeal ventilation | |
|---|---|
 In needle cricothyrotomy, the puncture is made through the cricothyroid membrane, between the thyroid and cricoid cartilage. | |
| Other names | Percutaneous transtracheal jet ventilation (PTJV); jet ventilation; needle cricothyrotomy; percutaneous transtracheal ventilation |
| Specialty | Emergency medicine |
| Complications | Catheter misplacement or blockage, bleeding, subcutaneous emphysema, pneumothorax, pneumomediastinum, vocal cord injury, esophageal perforation, laryngeal cartilages injury[1] |
Percutaneous translaryngeal ventilation (PTLV), also known as needle cricothyrotomy, is the delivery of oxygen to the lungs through an over-the-needle catheter inserted through the skin of the neck into the trachea.[2] It is typically done in young children, instead of surgical cricothyrotomy, in a cannot intubate cannot ventilate situation.[1] What counts as young varies from under 5 to under 12 years old.[1] It is also used as part of anesthesia for laryngeal surgery.[1]
The procedure involves placing a large needle through the cricothyroid membrane (CTM) directed towards the lungs.[1] Once in place the catheter is slid off the needle into the airway.[1] Oxygen is then delivered by high pressure jet ventilator or bag valve mask.[1] If using a bag valve mask intravenous tubing and a 2.5 endotracheal tube adapter is used to connect the components.[2] Oxygen is briefly given with great time provided for air to exit the lungs.[1]
The catheter may be sutured or tied into place.[1] Capnography can be used to verify it is in the correct place.[1] Complications may include catheter misplacement or blockage, bleeding, subcutaneous emphysema, pneumothorax, pneumomediastinum, vocal cord injury, esophageal perforation, and laryngeal cartilages injury.[1] Over time respiratory acidosis may develop.[2] As the procedure is rarely performed, having the equipment preprepared and doing simulation is important.[2]
References edit
- ^ a b c d e f g h i j k l m n o p q r Mace SE, Khan N (2008). "Needle cricothyrotomy". Emerg Med Clin North Am. 26 (4): 1085–101, xi. doi:10.1016/j.emc.2008.09.004. PMID 19059102. Archived from the original on 2021-08-28. Retrieved 2022-03-14.
- ^ a b c d Roberts and Hedges' clinical procedures in emergency medicine and acute care (Seventh ed.). Philadelphia, PA: Elsevier Health Sciences. 2019. p. 136. ISBN 9780323547949.