Percutaneous Transtracheal Ventilation Setup

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Dr. Jessica Mason reviews the setup for percutaneous transtracheal ventilation. In this technique, we use the angiocatheter from a central line kit (not a standard angiocatheter for peripheral access), a 10 cc flush, a 3 cc syringe with the plunger removed and the connector from a 7.0-7.5 ET tube inserted into the 3 cc syringe. With the flush attached to the angiocath, enter the cricothyroid membrane at 45 degrees aiming caudally while aspiring. When you see bubbles in the syringe you are in the trachea. Advance the catheter over the needle and remove the needle. Connect the angiocatheter to the 3 cc syringe with the ET tube connector. This allows you to attach a bag-valve and bag the patient. Many standard angiocatheters do not have a Luer lock connection so cannot connect to the syringe, and also have a filter at the top, so these should be avoided. This technique was described by Dr. Ilene Claudius in the C3 episode on Pediatric Airway.

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Bryce L. -

Great pearl on using angiocath from central line kit for luer-lock connection - thanks!

Dallas H. -

Has anyone actually used the angiocath from the central line kit in real life? Those angiocaths are very soft and easily collapse. I am concerned that angiocath might simply collapse under the tissue pressure, especially in an obese patient.

Jess Mason -

Yes I agree. Peds or maybe a thin adult/adolescent. It’s also a 20 gauge so it’s quite narrow.

William K. -

Jess and team great talk and something we all hope we never have to do. There are a few things to note on this.
1. The accessibility and already packaged material that is ready to go is key so when you need it it you are not searching for it.
2. I learned from a mentor on this topic and have used of a 3.0 or 3.5 ETT tip instead of the 7.0. They fit very well into the back of the angiocath then you can avoid needing the extra equipment of the 3cc syringe. I could see that maybe the 3 cc luer lock may allow for increased PIPs but it is also something else that can get snagged or pulled or that you have to add an additional step.

Jess Mason -

Thanks for posting this!

ST -

Your angiocaths look similar to the ones that my hospital stocks. On ours, that top piece with the filter actually pops off, and you can get a Luer lock syringe to connect. It's also useful for when you use the angiocath as a regular IV because it allows for continuous free flow of blood, i.e. you get flash, but you're not sure you're still in the vein because the little flash chamber is already full.

Jess Mason -

You are correct, the filter on this one can pop off and then have a Luer lock connection. I will plan to update this video to demonstrate that option. Thanks!

Katie F. -

Having seen this tried a few times, I would offer that although all of the parts fit, it is very much less than ideal. A jet catheter insufflator is essential for ventilation. The problem is that few places even know about the jet catheter insufflation set up, and few even have one. This should be essential equipment. About 4 decades or so ago I had a surgeon who had been in Vietnam and he was teaching needle cricothyrotomy and he offered that if you can put in one needle successfully through the cricothyroid membrane, you could put extend a incision laterally in both directions and then place an ET tube. I never found that you could ventilate quickly or effectively with attaching an AMBU to the catheter. The jet insufflator works much better for this purpose.

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