1. Clip hair and surgically prepare a 6 inch X 6 inch area of the ventral neck area just distal to the larynx.
2. For conscious MWDs, sedate and use 20 mg lidocaine locally.
3. Attach a 10 mL syringe to the hub of a 14 or 16 gauge, 6 inch, over-the-needle catheter.
4. Stabilize the trachea with one hand.
5. While holding the catheter-syringe apparatus at a 45° angle, direct the catheter through the skin and annular ring between the 3rd and 4th or 4th and 5th tracheal cartilages, directed ventrally down the trachea. Do not pass through the cricothyroid membrane in dogs.
6. Begin to slowly aspirate with the syringe as you pass the catheter through skin.
7. Once the tip of the needle is through the skin, aspiration of air signifies successful entry into the tracheal lumen.
8. Once the catheter is successfully introduced into the tracheal lumen, stabilize the needle to prevent any further advancement of the needle into the trachea.
9. Advance the catheter OFF the needle, directed down the trachea, until the hub of the catheter is in contact with the skin.
10. Remove the needle from the catheter.
11. Attach oxygen tubing to hub of catheter and provide high-flow oxygen (10-15 L/min).
12. Do not use this method for more than 30-45 minutes, as hypercapnia will develop and lung barotrauma may occur due to high airway pressures. Use tracheal insufflations as a “bridge” to more practical methods (e.g., orotracheal intubation, tracheostomy).