What is the preferred site of insertion for a percutaneous tracheostomy and what are the problems of insertion above or below this?

  • Preferred site of tracheostomy is between the 2nd and 3rd tracheal rings in the midline 1
  • Tracheostomy above this site:
    • Can lead to damage to the cricoid cartilage and first tracheal ring
    • Results in increased risk of subglottic stenosis which is difficult to treat 1
  • Tracheostomy below this site:
    • Can lead to damage to the thyroid and great vessels at the root of the neck
    • Results in increased risk of significant bleeding 1