The patient is positioned with the neck extended, with a intravenous fluid bag between the shoulder blades and the head in a head ring. This brings as much of the trachea as possible into the neck. The important landmarks have been drawn on the patient in the picture at left.
The larynx (hatched) and cricoid cartilage with the intervening cricothyroid membrane are identified. The suprasternal notch has also been marked. From the cricoid, moving caudally, the tracheal rings are identified. The tracheostomy should ideally pass between the second and third tracheal rings, although a space one higher or lower may be employed. Placing the airway higher, next to the cricoid can cause tracheal erosion and long term problems.