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FIGURE 22.73

Melker Cricothyroidotomy Kit. Components of the kit produced by Cook Inc. (www.cookmedical.com). (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.74

Identify Landmarks. Palpate thyroid cartilage and cricothyroid cartilage caudally. Angle needle 30 degrees caudad to enter the trachea (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.75

Bubbles During Aspiration. Aspiration of bubbles during needle advancement confirms tracheal placement. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.76

Slide Catheter into Trachea. Carefully slide the catheter off the needle into the trachea. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.77

Confirm Tracheal Placement. Again, aspirate bubbles from the catheter to confirm tracheal placement. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.78

Thread Wire. Lack of resistance during threading of Seldinger wire confirms tracheal placement. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.79

Incision at Wire Entry Site. Remove catheter and make incision at the wire entry site. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.80

Insert Tracheostomy Tube/Introducer. Insert both devices over the wire and into the trachea. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.81

Remove Wire and Introducer. Remove these devices together as a single unit. (Photo contributor: Lawrence B. Stack, MD.)

Equipment

The Melker kit manufactured by Cook Medical includes all the equipment necessary: catheter, thin-walled needle, Seldinger wire, cuffed tracheostomy tube 5.0 mm ID, and tapered introducer.

Technique

  1. Identify the thyroid cartilage and the cricothyroid membrane directly caudally.

  2. Prep the neck with suitable antiseptic; anesthetize the skin overlying the cricothyroid membrane with 1% lidocaine.

  3. Isolate the trachea between the thumb and 3rd finger of the sterilely gloved nondominant hand, using the index finger to palpate the cricothyroid membrane landmark. With a syringe attached, preferably containing sterile water or remaining lidocaine, insert the catheter through the cricothyroid membrane at a 30-degree angle to the horizontal, aiming toward the feet. Once through the skin, begin aspirating as the catheter is advanced. Air and bubbles entering the syringe confirm entry into the trachea.

  4. Carefully slide ...

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