Transtracheal aspiration is a technique for the collection of
bronchial secretions for laboratory evaluation and culture. This
technique is useful when standard sputum collection has not provided adequate
material or determination of the infective agent(s). Specimens collected
by this technique are free of contamination from nasal, oral, and
pharyngeal secretions. Pecora first described this technique in
1959.1 Several modifications to the original technique
have been made.2–5 This technique may be more
properly named transcricothyroid membrane aspiration.
The most superficial portion of the cervical airway begins at
the inferior thyroid cartilage and extends inferiorly to the thyroid
isthmus (Figure 18-1). The inferior border of the thyroid cartilage is
attached to the cricoid cartilage by the cricothyroid ligament.
This is formed by a thicker central conus elasticus and laterally
by thinner ligaments that are covered by the cricothyroid muscles (Figure
18-1B). The internal surface is covered
by the mucous membrane of the larynx. Collectively, this is often
referred to as the cricothyroid membrane or cricovocal membrane.
The paired cricothyroid arteries cross from lateral to medial to
form an arch that anteriorly crosses the upper one-third of the
cricothyroid membrane. The pyramidal lobe of the thyroid occasionally
extends superiorly to this level.
Anatomy of the airway structures of the neck. A. Topographic anatomy. B. The cartilaginous structures.
Transtracheal aspiration is indicated for the collection of tracheobronchial
secretions for laboratory evaluation. Often, previous attempts to
collect standard coughed and expectorated sputum samples have failed
to yield adequate samples or reveal the etiology of a pulmonary
infection. Patients who do not appear to be responding to the appropriate
antibiotic regimen that was indicated by evaluation and culture
of sputum samples may benefit from this technique to better determine
the pathogen(s). This is particularly true in cases of atypical
or mixed flora, as in suspected aspiration pneumonias, where this
technique may yield superior culture results when compared to sputum
Patients who are unable to cooperate with or tolerate the required
positioning should not be selected for this technique.7 Agitated
patients requiring sedation that may affect respiratory effort should
be avoided. Traumatically injured patients should have the cervical
spine cleared for possible injury prior to performing the procedure.
Patients with known or suspected blood dyscrasias (abnormal platelet counts,
elevated prothrombin or partial thromboplastin times) should not
be subjected to this technique due to the increased risk of tracheal
hemorrhage. The operator must be able to easily identify the patient’s
anatomic landmarks, including the thyroid and cricoid cartilages
and the intervening membrane space. Patients with abnormal or distorted
anatomy should be excluded. Patients who are endotracheally intubated
or have a tracheostomy do not require this procedure.
- Sterile gown, gloves, and mask
- Pillow or padding for shoulders
- Povidone iodine solution or alternative cleansing solution
- Sterile gauze ...
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