What gauge needle for transtracheal injection

[turnupthevapor]

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I was wondering what gauge needle you are all using for your transtracheal injections?

For me it makes the most sense to youse an 18 gauge angiocath and leave the catheter in place so a wire can be inserted through it or jet ventilation can be performed. However, I have never done this! I have only used 22 gauge out of fear of trauma and bleeding.

What has been all you warriors experience?

Thanks for the input

 

[Mman]

I rarely do transtracheal blocks, but when I do I usually just use a 25 g needle. I see no reason to make a larger hole in their trachea (or any other tissues I might be passing through) than necessary to deposit the lidocaine.

I will usually just serially dilate their nares with nasal airways lubed in lidocaine gel. After that, I'll use extension tubing with an atomizer on the end (can't remember the brand) or just an LTA kit stuck down the nose to the posterior pharynx. Then have them take a big breath in while I push as fast as I can before they start coughing. That usually coats their cords and upper trachea fairly well and with a little dexmeditomidine and/or ketamine they do just fine.

 

[Idiopathic]

22 because its longer than our 25s.

sounds like you are talking about emergency ventilatory support however. in that case the answer is 14 gauge for both needle crike and needle thoracentesis

 

[jwk]

I rarely do transtracheal blocks, but when I do I usually just use a 25 g needle. I see no reason to make a larger hole in their trachea (or any other tissues I might be passing through) than necessary to deposit the lidocaine.

I will usually just serially dilate their nares with nasal airways lubed in lidocaine gel. After that, I'll use extension tubing with an atomizer on the end (can't remember the brand) or just an LTA kit stuck down the nose to the posterior pharynx. Then have them take a big breath in while I push as fast as I can before they start coughing. That usually coats their cords and upper trachea fairly well and with a little dexmeditomidine and/or ketamine they do just fine.

I use a 21ga. Still a small hole (certainly smaller than the 18ga) but you can inject the lidocaine much quicker than with a 25ga needle.