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 procedure👩‍⚕️👨‍⚕️
 
Here’s what you need to know about cannula cricothyroidotomy:
 
Equipment:
 
14G Insyte IV cannula 💉
5ml luer lock syringe 💉
10ml 0.9% saline ampoule 💧
RapidO2 insufflation device 🌬️
 
Procedure:
 
1️⃣ Allocate roles 👥
 
2️⃣ Prepare the kit 🧰
🔺 Draw up 2ml saline in 5ml syringe 💧
🔺 Remove the cap at the back of the cannula and connect syringe 🔗
🔺 Open Rapid O2 device and connect to an oxygen outlet at 15L/min 💨
 
3️⃣ Prepare the neck 🧴
🔺 Extend the neck and swab the area with an alcohol swab 🧼
🔺 Another operator may continue trying to oxygenate via the mouth, but ideally should place an oropharyngeal airway or LMA.
🔺 Identify cricothyroid membrane +/- inject adrenaline-containing solution 💊
 
4️⃣ Access trachea 🫁
🔺 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 🌬️
🔺 Stabilize the cannula by holding the flashback chamber with one hand ✋
🔺 Advance the sheath into the trachea ➡️
 
5️⃣ Confirm position ✅
🔺 Remove the air from the syringe and reconnect it to the cannula 🔄
🔺 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) 🫁
🔺 Connect the Luer Lock connection of the Rapid O2 Device 🔗
 
6️⃣ Oxygenate
🔺 Deliver 1L of oxygen by occluding the outlet of the Rapid O2 device with thumb for 4 seconds (15L/min = 250ml/sec) ⏲️
🔺 Release thumb and wait until oxygen saturations return to >90%, or 30 seconds if there is no reliable oxygen reading 📈
🔺 Deliver a further 500ml of oxygen (2 seconds) every 30 seconds ⏲️
 
7️⃣ Green Zone Discussion 🟢
🔺 Confirm your team is in the Green Zone and take the opportunity to pause and discuss the next steps 🗣️.
 
Build Knowledge ✅
Improve Safety ✅
 
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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