Applying cricoid pressure is an essential skill for nurses, however many are unaware of the correct technique.

Cricoid pressure is the application of pressure on the cricoid cartilage to prevent aspiration during rapid induction of general anesthesia. Correct application means knowing where to apply, when to apply, how much pressure to apply, and when to release it. A study found that 95% of nurses were unable to identify the correct amount of force required to occlude the esophagus and that 87% were incapable of applying the correct amount of force.1 The nurses in the study were perioperative nurses who applied cricoid pressure on a daily basis.1 Another study found that 13.7% of the 51 perioperative nurses tested applied the correct pressure to a model of a trachea on a scale, however only 3.9% could apply the correct amount of pressure in the correct location.2 Most revealing, one researcher found that 0% could apply the correct pressure in the correct location and answer four questions regarding the correct application of cricoid pressure.2

Using subtasks

The appropriate application of cricoid pressure can be broken down into subtasks. These tasks are the ability to locate the cricoid cartilage, the knowledge of where to apply pressure, when to apply and release pressure, the ability to apply pressure in the correct direction, and the ability to apply the correct amount of force.3 Correctly applied cricoid pressure will enhance the view required for intubation. The downward force should be between 30 and 40 N (9.81 N equals 1 kg). This translates into approximately 6.6 to 8.8 pounds (3 to 4 kg) of straight downward force on the cricoid cartilage. This downward force is significant enough to compress the esophageal lumen between the cricoid cartilage and the cervical vertebrae.4-6

Education required

Correct application of cricoid pressure can be taught with an inservice that includes both didactic and hands-on training. The inservice should include information about the anatomy of the neck, the physiology behind regurgitation, the amount of force required, and the correct timing for the initiation of pressure and release of pressure. Time should be allowed for hands-on practice using scales and life-sized models of the neck. During the hands-on practice, participants are able to visualize the weight displayed on the scale in association with the amount of pressure they exerted.

At the conclusion of an education program, resear-chers found that 94.1% of the perioperative nurses could identify the correct amount of pressure from a list of options.2 The correct location of the cricoid cartilage was identified on the model by 100% of the perioperative nurses with 68.6% applying the correct amount of pressure. Adequate time should be provided to allow repetitive practice with the model and scale. Limited time for this program resulted in 68.6% of the nurses applying the correct amount of pressure. OR

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