CICO: Cannula Technique

airway emergency airway management cannula technique cico oxygenation patient safety Jul 29, 2024
Although nobody likes to think about a CICO situation, your team MUST have a shared mental model for how to prime and perform it, and participate in frequent simulation training. The choice of which CICO technique is a decision made at the time by the person performing the procedureπŸ‘©‍βš•οΈπŸ‘¨‍βš•οΈ
 
Here’s what you need to know about cannula cricothyroidotomy:
 
Equipment:
 
14G Insyte IV cannula πŸ’‰
5ml luer lock syringe πŸ’‰
10ml 0.9% saline ampoule πŸ’§
RapidO2 insufflation device 🌬️
 
Procedure:
 
1️⃣ Allocate roles πŸ‘₯
 
2️⃣ Prepare the kit 🧰
πŸ”Ί Draw up 2ml saline in 5ml syringe πŸ’§
πŸ”Ί Remove the cap at the back of the cannula and connect syringe πŸ”—
πŸ”Ί Open Rapid O2 device and connect to an oxygen outlet at 15L/min πŸ’¨
 
3️⃣ Prepare the neck 🧴
πŸ”Ί Extend the neck and swab the area with an alcohol swab 🧼
πŸ”Ί Another operator may continue trying to oxygenate via the mouth, but ideally should place an oropharyngeal airway or LMA.
πŸ”Ί Identify cricothyroid membrane +/- inject adrenaline-containing solution πŸ’Š
 
4️⃣ Access trachea 🫁
πŸ”Ί Puncture the cricothyroid membrane while retracting the plunger until air appears in the barrel, indicating the tip of the needle is in the air-filled trachea 🌬️
πŸ”Ί Stabilize the cannula by holding the flashback chamber with one hand βœ‹
πŸ”Ί Advance the sheath into the trachea ➑️
 
5️⃣ Confirm position βœ…
πŸ”Ί Remove the air from the syringe and reconnect it to the cannula πŸ”„
πŸ”Ί Retract the plunger to confirm air enters the syringe (this confirms the tip of the cannula is in the trachea, and not in the neck tissue) 🫁
πŸ”Ί Connect the Luer Lock connection of the Rapid O2 Device πŸ”—
 
6️⃣ Oxygenate
πŸ”Ί Deliver 1L of oxygen by occluding the outlet of the Rapid O2 device with thumb for 4 seconds (15L/min = 250ml/sec) ⏲️
πŸ”Ί Release thumb and wait until oxygen saturations return to >90%, or 30 seconds if there is no reliable oxygen reading πŸ“ˆ
πŸ”Ί Deliver a further 500ml of oxygen (2 seconds) every 30 seconds ⏲️
 
7️⃣ Green Zone Discussion 🟒
πŸ”Ί Confirm your team is in the Green Zone and take the opportunity to pause and discuss the next steps πŸ—£οΈ.
 
Build Knowledge βœ…
Improve Safety βœ…
 
Note: Periop Concepts supports training and education using the Royal Perth Hospital/Andy Heard technique for both cannula and scalpel cricothyroidotomy. Your centre may use a different approach. Always follow local guidelines and ensure your team has a shared understanding of this approach.
 

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