The Melker Kit
Dec 05, 2024
The Last Resort - Melker Kits Explained
We’ve all seen them, those kits sitting at the bottom of our trolleys, rarely used and forever expiring!
What exactly is in a Melker kit? When would it be used? And what can you expect if you’re in a situation where it’s needed?
Here, we demystify the Melker kit, so the next time it gets opened, you know exactly what you are looking at!
The Melker universal cuffed emergency cricothyrotomy catheter set is a kit designed for emergency airway access in the event that endotracheal intubation cannot be performed. The kit contains equipment to facilitate airway access either percutaneously (known as the Seldinger technique) or via a surgical technique through the cricothyroid membrane.
The kit contains the following equipment:
- π οΈ Cuffed cricothyrotomy catheter
- π Introducer needle
- π§ Syringe
- πͺ Scalpels - #15 mini and #20
- π§ Guide wire
- π Dilators
- πͺ Tracheal hook
- π·οΈ Trachy tape
- π©Ή Drape and gauze sponges
The Seldinger technique is not too dissimilar from insertion of a central line, which is far more familiar to most anaesthetists when compared with the surgical technique.
Choice of technique will depend on the anaesthetist performing the procedure, with no real evidence to suggest superiority of one technique vs the other. Factors affecting choice include:
- π Seldinger: familiarity of Seldinger technique, smaller neck wound, less bleeding
- π οΈ Surgical: speed of insertion, simplicity of technique with less equipment needed
If a CICO event has occurred and cannula access to the neck and oxygenation has been established, progression to Melker insertion can still be achieved as the guide wire can be used through any large bore cannula (i.e. it does not need to be the introducer needle from the kit).
A procedural videoπ₯ detailing the steps of Melker insertion can be found on the Cook Medical website. The Melker kit also contains a complete instruction sheet for use at the time of insertion.
π Build Knowledge β
π‘οΈ Improve Safety β
References:
Cook Medical (2024). Melker Emergency Cricothyrotomy Catheter Set. https://www.cookmedical.com/products/cc_tccs_webds/
Patel, B., Frerk, C. (2008). Large-bore cricothyroidotomy devices. BJA Continuing education. V8(5) pp 157 -160. DOI: 10.1093/bjaceaccp/mkn029
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