Local anaesthetic with adrenaline is infiltrated subcutaneously, and a 1cm incision made horizontally with a scalpel. Keeping in the midline at all times, the introducer needle and syringe are advanced, at 45 degrees to the skin, until air is aspirated from the trachea.
The guidewire is passed through the needle, then the small dilator (green) is passed. this is then removed and the white introducer passed into the trachea. The guidewire is removed. Now only the white introducer is left in the trachea.