- To provide an airway when all other methods have failed or the airway or ventilation cannot be achieved by any other intervention.
- Complete airway obstruction in patients older than six (6) years of age where all other clearing methods have failed, including attempts to push obstruction to the right bronchus.
- Failed intubation, as a last resort to secure an airway in a severely compromised patient, who cannot be ventilated or oxygenated by any other means.
- Aspiration of blood or stomach contents.
- Incorrect placement.
- Oesophageal perforation or laceration.
- Where possible, store the tracheal dilator in packaging to minimise infection risk.
- All equipment involved in this procedure is single use only.
- All relevant infection control methods to be utilised.
- Prepare equipment required:
- Bougie
- Size 5.5 ETT
- Alcohol/betadine swab
- BVM
- Cobbs connector
- Disposable scalpel
- Tracheal Dilator
- Oxygen
- Suction
- Tape
- End Tidal monitoring
- Position patient supine.
- Extend the patient’s head.
- Locate the cricothyroid membrane.
- Stabilising the larynx with the thumb and middle finger use forefinger to identify landmark. Ensure suction is ready.
- Swab the site with an alcohol swab and make an incision transversely with a scalpel (maximum depth 1cm, maximum width 2cms) until airflow is heard or felt escaping from the incision.
- Insert the tracheal dilator into the incision. The tracheal dilator is ergonomically designed with tips that are bent at almost right angles to the rest of the device (see image below).
- Open the surgical incision by using the tracheal dilator.
- Maintain visual contact with the surgical incision while widening the opening.
- Insert the tip of the bougie into the trachea
- Pass the 5.5 ETT over the bougie until the cuff is inside the trachea, inflate the cuff and manually secure. Remove the tracheal dilator and bougie and dispose of scalpel in sharps container.
- Connect BVM, bacterial filter and end tidal and cobbs connecter, assist ventilation and auscultate chest.
Perform ventilation assessment and document checks:
- Adequate rise and fall of chest
- Auscultation of left and right lungs.
- End tidal CO2 waveform and reading in mmHg
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