Top Tip 13 - Needle tracheotomies

Upper airway obstructions are not seen every day, even in emergency centres. However, clinicians need to move fast when such a case presents. Not every clinic keeps a tracheostomy tube on hand for the once-in-a-blue-moon case. Fortunately there is a practical, readily available alternative.

Needle tracheotomy is an extremely simple technique for rapidly alleviating an upper airway obstruction if tracheostomy tubes are not available.

Here’s our basic approach to performing a needle tracheotomy:

Position the patient
Place the animal in dorsal recumbency with the neck hyperextended.

Place the tracheotomy needle/catheter
Advance either a hypodermic needle or catheter-over-needle (16-18g for cats, 10-16g for dogs) through the skin along the ventral midline and through the tracheal wall whilst stabilising the trachea with your other hand. An airway is now established with the diameter dependent on the size needle or catheter which has been used.

Create a connector
The needle or catheter is then attached to a 3ml syringe which has had the hub removed and replaced with the connector from a size 8 endotracheal tube. This, in turn, can be attached to a breathing circuit.

You may wish to keep a set appropriate gauge needles, syringes and an ET tube on hand in your crash cart for needle tracheotomies.

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