Retrograde Tracheal IntubationRetrograde Tracheal Intubation
1. Puncture cricothyroid membrane with needle.
2. Pass guide wire through cricothyroid needle aimed superiorly so that distal end of wire may be retrieved from mouth (or, if desired, nose) of patient. Withdraw needle off wire.
3. Load ETT over oral (or nasal) end of wire, passing wire into tube through Murphy's eye.
4. Pull wire relatively taught and straight.
5. Advance ETT over wire into trachea to cricoid area, then, gradually relaxing cricothyroid end of wire, advance ETT to appropriate intratracheal location.
6. Release cricothyroid end of wire and withdraw wire out of ETT.
Fiberoptic-assisted retrograde technic
1. Prepare fiberoptic scope.
2. Load ETT onto fiberscope.
3. Perform cricothyroid puncture and pass wire through needle and out mouth (or nose). Withdraw needle off wire.
4. Pass guide wire through suction lumen of fiberscope.
5. Pull wire relatively taught and straight.
6. Advance fiberscope along wire past vocal cords to cricothyroid area. Observe tracheal rings.
7. Cricothyroid end of wire may be released as fiberscope is advanced to carina and wire then pulled out of fiberscope; or wire may be pulled out inferiorly through cricothyroid puncture and fiberscope then advanced to carina.
8. Advance ETT over fiberscope into trachea.
9. Hold ETT in place while withdrawing fiberscope and confirming appropriate intratracheal location of ETT.