The most important benefit of PTJV in this study was immediate oxygenation. Throughout the procedure, pulse O2 saturation was maintained at > 90% with the use of PTJV. Arterial blood gas tests were not performed because PTJV was used as temporary, resuscitative procedure until a permanent airway was secured for oxygenation and ventilation. Cote and coworkers have shown that in dogs, adequate ventilation and oxygenation can be obtained using a 12-gauge (ID, 2.8 mm) angiocath needle and a self-inflating bag. Yealy and colleagues have suggested that a 16-gauge or larger angiocath needle, preferably a 12-gauge angiocath needle, should be used when jet ventilation is administered. Catheters of these sizes will ensure delivery of a tidal volume adequate to maintain oxygenation and ventilation in apneic adults. In addition to ensuring adequate oxygenation (or even hyperoxygenation), this technique produces normocapnia or hypocapnia. In my experience, intermittent jets of oxygen (at 50 psi) administered through a regular 12-gauge IV angiocath or a special transtracheal catheter (6F; ID, 2 mm) provide a pressure gradient sufficient to achieve a good flow for oxygenation and ventilation. more
Complications in this case series were due to an improper catheter insertion technique, a kinked catheter, or to unusual anatomy leading to catheter misplacement. None of the complications were fatal. Other authors- have reported similar low complication rates, including hemorrhage at the insertion site, subcutaneous or mediastinal emphysema, esophageal injury, and pneumothorax. Other potential complications that can occur during the insertion of the angiocath into the trachea are perforation of the posterior wall of the trachea and injury to the esophagus. To avoid displacement, the catheter should be held manually against the skin. It is imperative to verify that air can be aspirated from the catheter with a syringe after the cricothyroid membrane puncture is made. If a catheter kink is suspected, then the catheter should be removed and replaced with a new one. Regular IV angiocatheters are thin walled and can easily kink compared to special transtracheal catheters (6F) for PTJV that are firm, pliable, and resist kinking. A thick special-walled transtracheal catheter is preferred for use during PTJV to decrease the risk of kinking.