Quote:
Originally Posted by Doc Dutch
RF,
I do think next time (because there is always a next time or so it seems) I will go with the 16 or 14 gauge if I can find it readily. Bigger would have been better as it probably affords less kinking. I also agree with you that pointing the angiocatheter caudal and sliding the needle out once the angiocath is in or pushing in the catheter and removing the needle. I am not sure as to why for the first few attempts I could not pass the catheter over the needle and into the trachea. That was frustrating.
The retrograde intubation is a great idea. I have actually used this in another pediatric case (10 year old with c-spine and a t-spine fractures in a halo that lost his airway). The anesthesiologist and I did it together. Now that was "un-fun", but is really good to have in your arsenal of airway tools.
D-
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Just re-read this thread, and focused on the trouble you had threadding the cath.
With over the needle caths, the cath is larger than the needle puncture. It is not uncommon for the cath to become distorted as it trys to pass through the skin. It does happen on periph lines and can cause phlebitis after a day or so. The neck tissues in the newborn could well have distorted the cath to the point the cath just would not thread for you.
A small trick I generally did on all ONC line placements was to use the needle tip to make a small skin nick, or incision, to allow for the larger cath to pass without distortion. Try this if you have to do another needle thyrotomy again.
Best regards.
RF 1