Percutaneous needle methods generally require purpose-made kits that are usually stored on a dedicated difficult airway trolley. The kits are rarely used, and hence may seldom be checked or practised with. Broadly speaking they can be divided into:

• Narrow-bore, which are <3 mm, e.g. Venflon
• Wide-bore, i.e. ≥3 mm

Narrow-bore techniques rely on a patent upper airway for exhalation and require high pressure insufflation for gas movement. Therefore, they are contraindicated in complete airway obstruction.

Wide-bore techniques require at least a partially patent upper airway and are unlikely to achieve normal CO₂ clearance. Some wide-bore kits have a balloon to achieve a protected airway.

The surgical technique requires a scalpel, bougie and endotracheal tube as a minimum. Some prefer to use bespoke kits, which can include dedicated tubes, tracheal dilators or a tracheal hook. The surgical technique has been shown to have a far higher success rate than its percutaneous counterpart. The endotracheal tube accepts a standard 15 mm connection, so the patient can then be connected to a ventilator or a Mapleson C circuit as normal.