Percutaneous Transtracheal Ventilation: Assist

1.  The physician or advanced practice nurse locates the cricothyroid membrane.
2.  The physician or advanced practice nurse passes the over-the-needle catheter (with syringe attached) at a 45-degree angle caudally and cannulates the trachea through the cricothyroid membrane.

3.  Air will be aspirated into the syringe when the entrance to the trachea has been attained.
4.  Saline solution in the syringe makes it easier to see air bubbles during aspiration.
5.  The physician or advanced practice nurse removes the syringe and needle while manually stabilizing the catheter. The physician or advanced practice nurse advances the catheter caudally into the trachea.
6.  The physician or advanced practice nurse reconfirms endotracheal placement by aspirating air.
7.  For most adults, attach the catheter hub to the jet ventilator device. Refer to the lists for the appropriate initial pressures based on the patient's weight.
8.  There is no standard ventilatory device for PTV. The method described here can be accomplished with commonly available equipment. Other options include the use of intermittent high-pressure oxygen delivery by attaching noncollapsible tubing to an oxygen source at one end and to the catheter at the other.
9.  A regulating valve or a commercially available system (e.g., the Shrader blow gun) is attached to a high-pressure oxygen supply and placed within the system to allow for intermittent oxygen delivery.
10. The customary frequency of inflation is once every 5 seconds (12 breaths/min), and the duration for this method is 1 second or less. The chest rise is a good indicator of adequate inflation. If a high-pressure oxygen source is not available, ventilation may be attempted with a bag-valve-mask via the adaptor from a 3.0-mm endotracheal tube.
11. Remove the adaptor from the endotracheal tube, insert it into the catheter, attach a bag-valve-mask, and ventilate. This method is less effective than use of a high-pressure oxygen source, and ventilation may be very difficult, if not impossible.
12. Secure the catheter by holding it manually at all times, being careful not to bend or kink it.
13. Auscultate the patient's chest to assess ventilation. Visualize the chest for rise and fall as oxygen is delivered. Exhalation is passive from the glottis and, ultimately, from the mouth and nose