Pediatric Jet Insufflation

In children under 10, traditional cricothyrotomy is contraindicated due to their anatomy. To perform a needle cricothyrotomy a 12 or 14-gauge angiocatheter is inserted into the cricothyroid membrane. If the commercial kit is available, the oxygen delivery tubing with an on/off valve is attached and periodically insufflated for breaths. However, two alternatives exist when the commercial kit is not available. The end of a 3-5 endotracheal tube can be directly attached to the angiocatheter and a subsequent bag valve mask to the endotracheal tube tip. This circuit will have significant resistance although the patient can ultimately be ventilated. An additional option is to attach a 3 mL syringe with the plunger removed to the angiocatheter and the adapter of a 7-0 endotracheal tube can then be attached to the open end of the syringe.